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DUBLIN JOURNAL
OF
MEDICAL AND CHEMICAL SCIENCE;
a 4 — \,
aad ae ay
a" See : EXHIBITING
4 t- | qAL COMPREHENSIVE VIEW
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3 soul y rely OF THE
£2 ‘¢ LATEST DISCOVERIES
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MEDICINE, SURGERY, CHEMISTRY, AND THE COLLATERAL
SCIENCES.
DUBLIN:
PUBLISHED BY HODGES AND SMITH,
21, COLLEGE-GREEN ;
~ LONGMAN, REES, annCO., ann SIMPKIN ann MARSHALL, LONDON;
MACLACHLAN anv STEWART, EDINBURGH ; anp
SMITH ann SON, GLASGOW.
1834.
Printed by R. Gratsperry.
HISTORICAL - }
MEDICAL }
~ f
ep pe
-
*
CONTENTS OF No. XIE.
ORIGINAL COMMUNICATIONS.
Arr.
1. On some Compounds formed by the action of Chloride of Platinum
and Chloride of Tin. By Mr. Kang, - - : ° :
2. Report of a case of urinary Calculi, containing Human Teeth, removed
from the Female Bladder. By Grorce WiLitam O’Brisgn, M.D.,
3. Medical Cases and Observations. By Mr. Rices, ~ - -
4. Report of a Case in which a Foreign Body was supposed to be present
in the Trachea. By Ricuarp T. Evanson, M.D., - - -
6. Two Cases of Popliteal Aneurism. By Mr. Cottis, - z
7. Researches on Solidification of the Lungs in New-born Infants. By
Epwarpb Jorerc, P.D.C.M.B., - -
8. A Case in which a large Molar Tooth entered and nae Seong the
Larynx during the Operation of Extraction. By Joun Houston,
M.D., - - - - - - ° - - -
9, On the occasional Occurrence of Mental Incoherence during Natural
Labour. By W. F. Monrcomery, M.D., - - “ -
10. Practical Observations on the Treatment of some of the Diseases of the
Lungs, &c. By a" Lirrie, M.D., - - = -
BIBLIOGRAPHIC NOTICES.
Observations on Obstetric Auscultation, with an Analysis of the Evidences
of Pregnancy, and an Inquiry into the Proofs of the Life and Death of
the Foetus in Utero, by Evory Kennepy, M.D., - - -
Transactions of the Medical and Physical Society of Calcutta. Vol. vi. -
A Lecture on the functions of the Sere es by Rosgert J. Graves,
M.D., - - - -
Principles of Geology, by Gis os LYELL, iy “i M. G, S., - - -
SCIENTIFIC INTELLIGENCKE.
1. Chemical and Physical Science.
On the Development of Heat in the Flowers of the Caladium Pinnatifidum.
—Onthe Reduction of Mr. Faraday’s Discoveries in Magneto-Elec-
tric Induction to a general Law.—On the continued Rotation of a
closed Voltaic Circuit, by another closed Circuit.—Composition of
Mummy Powder.—Preparation of the Proto-tartrate of Meret and
Potash, : - “ “ - - - . - -
a
19
29
36
42
69
132
il CONTENTS.
2. Natural History.
Peculiarity inthe Respiration of the Crocodile, —- - - - - 138
3 Anatomy and Physiology.
Causes of the Presentation of the Head in Accouchement.—On the Develop-
; ment of the Hair an¢ Wool.—Action and sounds of the Heart.—-Ex-
tracts from the Life of Caspar Hauser.—Glandular Nature of the
Placenta, - - - - - = - ns - - 139
4. Pathology and Therapeutics.
Luxation of the Pubis in Labour.—Opium in Phthisis—Cholera among
the Insane.—Extra-uterine Pregnancy.—Hemorrhage between the
Placenta and the Chorion ; Abortion at seven months.—Vaccinaticn,
Cowpox.—Congenital Exstrophy of the Bladder, - - - - t5l
5. Surgery.
‘vane
nr
=
Torsion of the Arteries.—Lisfranc on Superficial Cancer, ° - -
CONTENTS OF No. XIV.
ORIGINAL COMMUNICATIONS.
Art. Page
11, On the Use of Mercury in Ulceration of the Cartilages of Joints. By
James O’ Beirne, M.D. - - - - - - - 159
12. A Case of Pneumo-thorax from Perforation. By Mr. Poor, - - 185
13. Surgical Report of Cases, treated in the Meath Hogpira! during the past
Year. By Mr. Porter - 3 > : - 189
ia. A Case of Trial for Poisoning by Wc. By eae Epwarpb
Bearry, M.D. - - - - . : - 203
15. Cases of certain Nervous Diseases, occurring principally in Females, with
Observations. By Mr. Cusack - - : : - - 220
16. Pathological Researches.—Inflammatory Affections of the Brain, and
its investing Membranes. By W. 1. Morcan, M.D. - ~ - 232
17. Cases of Uterine Hemorrhage. By Fieerwoop Cuurcnitt,M.D. - 244
BIBLIOGRAPHIC NOTICES.
Notices concerning Works on the Practice of Physic, Surgery, Pathology,
and Physiology, recently published in Germany, - - - 254
Cyclopedia of Practical Medicine, Part xix. : 2 - - - 269
Medical Periodicals in Germary, - - - - - “ - 275
SCIENTIFIC INTELLIGENCE.
1. Chemical and Physical Science.
Spark during the Freezing of Water by A‘ther.—Test for Hydrocyanic or
Prussic Acid, and Method of appreciating the Quantity.— Extract of
a Letter from Mr. William eiceery to M. a eh OF the Rota-
tory Movements of Camphor, - - : - 28]
2. Natural History.
Extract from a Paper read by Dr. Houston, at a Meeting of the Zoological
Society of Dublin, on the Diseases of the Animals which died in their
Collection, - - - - - - - > ~ - 285
3. Anatomy and Physiology.
Analysis of a Memoir on the Mechanism by which the Sounds of the Heart
are produced.— Discovery of Lymphatics in the Human Placenta and
Funis.—Observations on the supposed Vision of the Blood-vessels of
the Eye, - - - = - - - - - ~ 289
a
At | CONTENTS.
#
4. Pathology and Therapeutics.
Page
alic Bruit de Soufflet in Compression, or Engorgement of the Organs
contained within the Cranium.—Snow Blindness.—Experiments on
Cicuta and Henbane.—Treatment of Porrigo (Tinea).—lIodine An-
tidote for Strychine, &c.—On the Poisonous Effects of the Cyanuret
of Potassium, administered in the form of Enema.—Apparent Death
which was continued for twenty Days, - - -s = - 300
Enceph
5. Surgery.
Lacerated Perineum, Treatment of by Operation.—Hearing, through the
Apertures made by the Trephine.—Purification of Theatres of Dis-
section, &c.—Traumatic Tetanus.— Neuralgic A ffections of Stumps.—
On the Branchial or Gill-like Openings in the Neck of the Human
Foetus, as a Cause of certain Malformations.—Section of the Tendo
Achillis, as a Means of Cure for Club-foot (pied bot).—Re-union of
the Extremity of a Finger, which was completely cut off—On the
Employment of Casts, (moules en platre,) in the Cure of Fractures
of the Leg.— Worms in the Blood.—A Case of Scorching by Electric:
_ Fluid. —Wound of both Femoral Arteries without Hemorrhage, - 304
CONTENTS OF No. XV.
ORIGINAL COMMUNICATIONS.
Arr. Page
18. On Rupture of the Peritoneal Coat of the Uterus. By Mr. Wuire, - 325
19. On the Cause of the Pulse being affected by the Position of the Body.
By Mr. Travers R. Buacktey, - - - - - - 332
20. Some Considerations on Scrofula, and the various means of Cure em-
ployed at the Children’s Hospital, Paris, more particularly on the
Effects of Iodine in the Treatment of this Disease. By James Eacer,
Mi - - - - - - - - - 344
21. Report of the Obstetric Practice of the Wellesley Tenale Tnstitution
during the Year 1833. By Henry Maunszxtr, M.D. - - 367
22. Letter from Dr. Witi1aMs on the Subject of Asphyxia, - - - 380
23. Extract of a Letter from Dr. Arrowsmiru to Dr. Graves, - - 383
24. A Case of Constriction of the Aorta with Disease of its Valves, and an
Anomalous Tumour in the Right Hypochondrium. By Roszrr
Law Nixon, A.B. - - - - - - - - 386
25. Researches on the Diagnosis and Pathology of Aneurisms of the Great
Vessels. By Witriam Stoxes, M.D. - - - - - 400
26. Description of the Calculo-Fractor for Pulverizing the Calculus in the
Bladder. By Mr. Feancis L’Esrrance, - - - - 440
BIBLIOGRAPHIC NOTICES.
An Introduction to Botany, by Mr. Joun Linptey, - - - - 444
An Investigation into the Remarkable Medicinal Effects resulting from the
External Application of Veratria, by ALExANDER Turnsutt, M.D. 451
SCIENTIFIC INTELLIGENCE.
1. Chemical and Physical Science.
On a Method of so far Increasing the Divergency of the two Rays in Cal-
careous Spar, that only one Image may be seen at a time.—Professor
Faraday’s Recent Discoveries.—On the Action of Gases hurtful
to Vegetation.—Experiments with Potassium and Sodium.—On the
Influence of successive Impulses of Light upon the Retina, - - 462
2. Natural History.
Remarkable Skulls found in Peruu—Communication from Professor Scouler
on the above subject.—Mode of Flattening the Head among the
Tribes on the Columbia.—-Rapidity of Msge@hle Ona
Introduction of Frogs into Ireland, - - - 478
a
ig
CONTENTS.
3. Anatomy and Physiology.
Remarks on an Anastomosis recently observed outside of the Liver, between
the Vena Porte and the Vena Cava inferior.—Professor Mont-
gomery’s successful Injection of the Lymphatics in the Umbilical
Cord.— Difference between Growth and Development ; Observations
on Precocity ; Relations of the Genital System to the Growth of the
Body - - - - - - - - : - -
4. Pathology and Therapeutics.
Reynaud’s Observations on the Tuberculous Diseases of Monkeys, as Com-
pared with those of Man.—Irregular Formation of the Breasts 5
Supernumerary Nipples.—Explanation of the Phenomena of Metal -
lic Tinkling.—Electricity for the Cure of Warts.—Relative Morta-
lity of Different Countries ; Influence of Civilization on Longevi-
ty; Mortality of Towns.—Ricord’s Treatment of the Ulceration of
the Os Tince, - : - - “ = : - 2
5. Surgery.
New Hernial Bandages ; Eolian Pads.—Ke-union of a Portion of the Thumb
entirely separated.—Caries of the Spine affecting the Cervical and
Lumbar Portions.—Cancer of the Diploé, and of the Medullary
Canal of each Femur, - - - - - - - =
NOTICE.
481
484
493
We have been prevented, by an unavoidable circumstance, inserting the Re-
view of Dr. Blundell’s Work on Midwifery: it shall appear in our next Number.
THE
DUBLIN JOURNAL
- MEDICAL AND CHEMICAL SCIENCE.
1 MARCH, 1834.
“ PART I.
YF ORIGINAL COMMUNICATIONS.
tent son some Compounds formed by the Action of Chlo-
pide of Platinum and Chloride of Tin. By Rosert J.
Kane, M.R.1.A., Professor of Chemistry to the Apothe-
caries’ Hall of Ireland, Corresponding Member of the So-
cieties of Pharmacy and of Medical Chemistry, of Paris,
&e. &e.
A\w accidental observation of the intensely red colour produced
by mixing solutions of proto-chloride of tin and of per-chloride
of platinum, induced me to examine into the nature of their mu-
tual reaction at considerable length. I had very nearly reached
the termination of my labours, when the records of them were,
by some accident, mislaid; and except so far as my memory
could serve, [lost every corrected statement of those results, to
obtaming which I had devoted a space of many months. I re-
solved to recommence the investigation at a future period. J
have subsequently attempted to put that resolution into prac-
tice, but have not been able to devote to it the necessary time.
Still less do I now see any probability of having at my disposal
VOL. Vv. NO. 13. B
S
vo
Mr. Kane, on some Compounds of
sufficient leisure ; and have therefore resolved, as I cannot
again myself complete this train of research, to bring forward such
a general account of the novel phenomena that I observed, as
may have the effect of inciting others to the task. I fortunately
possessed in the laboratory book such accounts of the experi-
ments as may be sufficient for that purpose.
A solution of the chloro-stannite of ammonium (first de-
scribed by my friend Dr. Apjohn) was placed to. evaporate in
an unglazed biscuit ware capsule, in which there had been many
weeks before chloride of platinum. The tin solution eradually
became coloured red, and seeking for the cause of this, it ap-
peared that the trace of platinum, which the dish had absorbed,
was sufficient to colour intensely the solution of the chloro-
stannite. To verify this rationale I mixed together solutions of
proto-chloride of tin and per-chloride of platinum. A splendid
red colour was immediately produced. To determine the nature
ofthe body formed by the union of the two chlorides, and which
possesses this brilliant tint, was the object of my future investi-
gations.
Per-chloride of platinum and crystallized proto-chloride of
tin were dissolved separately in small portions of water, and the
solutions mixed: they became instantly of an intense wine red
colour. This red liquor was divided into two equal portions ;
one portion was evaporated very cautiously nearly to dryness,
when on cooling it solidified into a mass of intensely deep rec
crystals, very deliquescent, and staining the skin brown. ‘They
were soluble in a small quantity of water, in alcohol and in
ether ; these solutions were red. When they were evaporated
the substance again separated in the crystalline form. It crystal-
lized more readily from its etherial than from its alcoholic or
watery solution.
These crystals are in plates, presenting an appearance like
moirée metallique. When heated they give out much water
acidulated with muriatic acid, (they had not been weil dried),
some chloride of tin, and finally, after having been subjected
the Chlorides of Platinum and Tin. S
to a full red heat, metallic platinum and some peroxide of tin
remains behind.
Although soluble in a small quantity of water, this sub-
stance is totally decomposed by a larger quantity 5 ared pow-
der separating, which, when dried, becomes brown. ‘These
erystals are soluble in muriatic acid; the solution is reddish
brown, and contains proto-chlorides of tin and platinum; the
addition of potash not producing the separation of any chloro-
platinate of potassium.
These crystals are, as was mentioned before, decomposed
by much water: in order to examine the products of this de-
composition, a quantity of the crystals was mixed with a large
quantity ef water; a considerable quantity of red precipitate
immediately fell: this was separated by the filter.
The liquor was acid. It contained free muriatic acid, a
mixture of proto-chloride of tin, and much per-chloride. It did
not contain any platinum.
The precipitate in drying became of a brown colour; it had
not any trace of crystalline structure. It was totally indissolu-
ble in water. When heated it gives out a white vapour which
reddens litmus paper, and condenses into a white solid matter
(chloride of tin). Metallic platinum, mixed with some per-
oxide of tin, remains behind.
When acted on by nitric acid it forms a yellow liquor,
from which per-oxide of tin is separated. When digested with
muriatic acid it dissolves, forming a fine red solution, very
similar to the original one. When acted on by an alcali, a
black powder is formed. We shall recur to the detail of these
reactions presently.
In order to analyze this powder, the following method was
pursued :
‘Twenty grains of the red powder were boiled in water of am-
monia until it was converted totally into the black powder. The
water of ammonia was then neutralized, and nitrate of silver
added. Chloride of silver was thrown down, which whea
2 Mr. Kane on some Compounds of
dried weighed 18.2 grains, equivalent to 4.48 grains of chlo-
rine.
Twenty grains of the red powder were boiled in aqua regia
until they dissolved entirely. The solution was then evaporated
nearly to dryness. Nitric acid was added to it in excess and it
was again evaporated: when nearly dry a quantity of water was
poured on it, when a considerable quantity of per-oxide of tin
was precipitated, which, separated by the filterer and ignited,
weighed 12.2 grains, equivalent to 9.6 grains of metallic tin.
The liquor from which the tin was thus separated contained
all the platinum as per-chloride. It was considerably concen-
trated and then mixed with sal-ammoniac and alcohol. The
scarcely soluble chloro-platinate of ammonium which was
thrown down having been collected, weighed 10.7 grains, equi-
valent to 8.13 grains of bi-chloride, or to 4.73 of metallic
platinum.
By this analysis there were obtained from twenty grains of
the powder,
Chlorine = 4.48
Tin = 9.60
Platinum — 4.73
18.81
The platinum existed evidently as proto-chloride, and it 1s
very probable that the rest of the chlorine existed in the state
of proto-chloride of tin. Now the platinum, united with 1.69
grains of chlorine to form proto-chloride, and the remaining
2.79 gains of chlorine converts into proto-chloride 4.64 grains,
or very nearly exactly one half of the tin. In what state of
combination was the other half? Let. us call to mind that
when proto-chloride of tin is decomposed by much water, a
white powder falls which contains pro-toxide and proto-chloride
of tin, the tin being evenly divided between the two. It is
evident that the proto-chloride of tin, existing in the crystalline
substance, was decomposed by the large quantity of water, and
the Chlorides of Platinum and Tin. 5
we consequently obtained as much prot-oxide as proto-chloride
of that metal in the precipitate.
Arranging, therefore, the results of the analysis on this
principle, we shall have
4.73 Platina 4.75 Platina } = 6.42 Chloride of platina.
1.69 Chlorine
4.48 Chlorine
2.79 Chlorine _ 743 Chloride of tin.
: 4.64 Tin
9.60 Tin d
4.96 Tin — 565 Oxide of t
69 Oxsiven } =. 5, xide of tin.
18.81
19.50
.50 loss.
20.00
Now calculating the atomic relations existing between these
proportions, we find them approximating very closely to
1 atom proto-chloride of platina = 134.20
12 atom proto-chloride of tin = 121.45
14 atom pro-toxide of tin = 100.35
356.00
and its formula,
(Ch. + Pt.) + 14(Ch. + 8n.) + 13 (O. + Sn.)
On that supposition the precipitate would contain in twenty
grains,
Proto-chloride of platina = 7,56
Proto-chloride of tin = 0.02
Pro-toxide of tin =H ,02
There is a slight deficiency in the quantity of platina de-
tained by experiment, and a trivial excess in the quantity of
proto-chloride of tin. But the coincidence is sufficiently close
to warrant us in considering such to be the real composition of
this body.
6 Mr. Kane on some Compounds of
This substance is soluble in muriatic acid. ‘The solution is
of a fine red colour, like the original liquor from which it had
been precipitated. It is not decomposed by water if the murt-
atic acid be considerably in excess. This solution, when eva-
porated, gives a soft crystalline mass, very acid, and resoluble in
water. These crystals were evidently composed of the chloro-
platinite of tin, united to chloride of hydrogen (muriatic acid),
and were evidently analogous to the oxygen salts which crystal-
lize with oxide of hydrogen (water) in combustion.
When this acid solution is mixed with solution of corrosive
sublimate, avery interesting effect is produced. The brown
powder is again thrown down, the corrosive sublimate uniting
with the muriatic acid. If the solutions be boiled together, a
different effect is produced; the proto-chloride is converted
into per-chloride of tin, while the corrosive sublimate loses
either one-half or the whole of its chlorine.
We know that the proto-chloride of platinum and the proto-
chloride of tin are both slightly negative, and their compound
should therefore act feebly as a chlorine acid. Hence it unites
with the positive chloride of hydrogen, forming a crystalline
compound; from which, corrosive sublimate, being a much
stronger acid, takes away the base; or we may suppose the
muriatic acid to combine separately with chlorides, and a mere
mixture of chloro-stannite and of chloro-platinite of hydrogen
to exist in solution. Which ever view we adopt will have many
analogous cases amongst the oxygen combinations. The former
is that which I prefer in consequence of the red colour which a
mere mixture should not possess.
By the action of much water the crystals are decomposed
into this reddish brown powder and muriatic acid. From the
analysis of the powder I therefore consider the crystals to be
composed of one atom of proto-chloride of platinum, and three
atoms of proto-chloride of tin. Its formula is (Ch. + Pt.) +
3 (Ch. + Sn.)
When ammonia acts on the crystals or on the red powder, it
the Chlorides of Platinum and Tin. 7
takes away the chlorine, and as much water is decomposed as
converts the metals into prot-oxide and the chlorine into muria-
‘tic acid. Sal-ammoniac exists in the liquor, and there remains
a jet black brilliant crystalline powder, which consists of plati-
num and tin, both in the state of pro-toxide.
This substance is insoluble in water, soluble in muriatic acid.
The solution is olive coloured, and containing platinum and tin,
both in proto-combination. This solution is decomposed by
water except it contains a considerable excess of acid. The
precipitate is of a dirty white colour. Solution of sal-ammo-
niac did not dissolve this powder. It was not acted on by so-
lution of nitrate of silver or of ioduret of potassium.
When heated nearly to redness there appeared a sudden
scattering, as if from an explosive disengagement of gas, and im-
mediately afterwards it suddenly glowed intensely as if burning
like tinder. During this combustion no gas was disengaged.
When the process was carried on in close vessels there was a
slight absorption of oxygen, but the combustion took place,
though less completely, in hydrogen and carbonic acid. After
this ignition the powder preserved all its external character. It
was, however, then insoluble in muriatic acid, and soluble in aqua
regia. The solution contained per-chlorides of platinum and
tin.
It is easy to explain this phenomenon. The black powder
is a combination of prot-oxide of platinum and prot-oxide of tin.
The former substance is decomposed at a low red heat, giving
out oxygen in which the prot-oxide of tin burns. The oxide of
platinum does not yield enough of oxygen to convert the whole
of the prot-oxide of tin into per-oxide, and therefore the combi-
nation is less brilliant in carbonic acid than in atmospheric
air.
The ammonia, by acting on the brown powder, takes away
nothing but muriatic acid; the metals remain in the same pro-
portions as in the brown powder, but both in the state of prot-
oxide. If, therefore, the analysis given above of that powder
8 Dr. O’Brien’s Case of Urinary Caleult
be correct, this brilliant black crystalline substance is composed
of one atom of prot-oxide of platinum, and three atoms of prot-
oxide of tin. Its formula 1s
(O. + Pt.) +3(0. +58n.)
When this crystalline powder is digested in solution of pot-
ash it loses its brilliant appearance and becomes dull. ‘The
liquor contains prot-oxide. of tin. The dull black powder 1s
prot-oxide of platinum. When the reddish brown powder, or
the red crystals are digested in solution of potash the same ef-
fect is produced; the chlorine and oxide of tin being dis-
solved, and the oxide of platinum alone remaining behind. If
the potash be considerably in excess, it takes up a quantity of
the oxide of platinum, and becomes greenish coloured. ‘This
oxide of platinum dissolves rapidly in muriatic acid.
T hope that the above description of these compounds may
be found sufficiently interesting to lead to a more perfect inves-
tigation. It must be imperfect to a certain extent, and I only
bring the subject now forward that it may be more completely
investigated by others.
Art. Il.—Report of a Case of Urinary Calculi, containing
Human Teeth, removed from the Hemale Bladder. By
Gerorce Witiiam O’Brren, M. D., Licentiate of the Royal
College of Surgeons in Ireland, and Surgeon to the Clare
Infirmary, Ennis
Mary Mac Manon, a labouring woman, aged fifty years, was
admitted into the county of Clare infirmary, on the 9th of Octo-
ber, 1833, suffermmg from symptoms of stone in the bladder.
She complained of severe pain, and appeared much harassed
and reduced by the complaint. |
The account she gave of her previous state of health was
not very satisfactory ; from her statement, however, it appeared
removed from the Female Bladder. 9
that about four months ago she became affected with acute pain
in the loins ; this, however, gradually diminished ; but was sue-
ceeded about six or seven weeks since, by difficulty in making
water. The desire to evacuate the bladder is now constant, and
the pain felt on attempting to do so quite excruciating, es-
pecially after the bladder has been completely emptied. The
flow of urine is at times altogether interrupted; and the
pain becomes then most severe until the evacuation is again re-
stored. For the last three days she has had complete retention.
hrregular shivering fits, followed by copious cold sweats and
by loss of appetite and rest, have contributed to reduce her to a
very helpless state.
Upon sounding the bladder, a seas can be distinctly felt,
and seems to be of considerable size. She states herself, that
once or twice, the stone came so close to the orifice, that she
has been able to scratch some of it off, with her finger.
The necessity for attempting to remove the stone having
been determined on, the patient was placed in the sitting pos-
ture on a chair, the legs being held asunder by an assistant. A
small forceps was now introduced, with which, after much trou-
ble, the calculus was seized ; but having broken on account of
its brittleness, it again slipped away from the instrument.
The forceps having been once more introduced, the calculus
was with great difficulty secured between its blades. An effort
was now made to bring it through the urethra, but after a long
trial, it altogether failed. Finding that the stone could not be
got thus to pass, a small incision (about a quarter of an inch
long) was made, with a blunt pointed bistoury, in the ante-
rior part of the urethra, as being the most convenient di-
rection. On this being done, the calculus was readily extracted.
It was of an oval shape, with its sides much flattened, and
one of them smooth as if it had rubbed against another stone.
From the opposite side appeared a projection about a quarter
of an inch in length, presenting a striking resemblance to a hu-
~ VOL. Vv. NO. 13. C
10 Dr. O’Brien’s Case of Urinary Calcul
man tooth, with the fang turned outwards. On clearing away
the calculous matter from around this projecting body, it proved
to be indeed a human tooth ; one of the molars possessed of a
perfect covering of enamel.
During the operation the patient fainted, and continued so
weak that it was necessary to remove her immediately to bed.
A fuli opiate was administered and she remained tranquil for a
few hours; at the end of this time, however, another paroxysm
of pain came on, and after much suffering another calculus came
away. From this time she got complete and permanent relief.
This second calculus was of an egg shape, somewhat larger
than the first, and quite smooth. On examination it hada
glossy appearance at one end, which on being scraped presented
the extremity of another tooth.
The patient slept well on the night after the operation,
(which she had not done for some time before,) and she ex-
pressed herself as having been greatly relieved. The urine at
first flowed freely and constantly through the wound, which,
however, had completely healed in a week. Her amendment
was now in every respect rapid. She could retain her urine
perfectly, and her general health and appearance were much
improved.
In reply to our inquiries, she could give no account of the
teeth which had been found in her bladder, nor had she any idea
of their being there; but mentioned that all her teeth had been
loose for the last thirty years ; since she had taken mercury for
a venereal complaint, communicated by her husband. A num-
ber of her teeth had from time to time fallen out; some
having been found in her bed, which had dropped out at night,
while she was asleep; but she could not say that every one had.
been found that had dropped out. She had not had any serious
illness from the time she had taken mercury until the present
attack ; and at no time did ske appear to have had any complaint
like inflammation in the abdomen. We are therefore left
wholly to conjecture, in attempting to account for the novel
removed from the Female Bladder. 11
phenomenon, of human teeth being found to constitute the nu-
clei of stone in the bladder.
In attempting to account for the presence of the teeth in this
situation, it has been supposed that they may have been swal-
lowed and so have passed by ulceration from the intestinal ca-
nal to the bladder ; but this mode of accounting for the pheno-
menon, is the more difficult, from the absence of all antecedent
symptoms of abdominal disease, and the occurrence having
taken place in the female ; unless indeed we may suppose the
communication with the bladder to have occurred far up in the
intestinal canal. The generation of the teeth in a diseased ova-
rium, and their transit thence to the bladder, is a supposition
equally difficult to reconcile with the history of the case ; and we
are left but one mode of accounting for the occurrence, by sup-
posing that the teeth may have been introduced by the patient
herself ; an explanation for which there is no sanction in any
thing that could be gleaned from the history of the case; but
which certainly derives countenance from the records of some
extraordinary cases of this description. I have not been my-
self, however, led to adopt this opinion, but rather incline to
the idea of the teeth having found their way from the intestinal
canal into the bladder; though nothing in the history of the
case enables me to account for their having done so. What
was of most consequence to the patient, however, she was dis-
charged from the hospital perfectly well, on the 12th of Octo-
ber; after having been nine days under treatment.
12: Mr. Riggs’ Medical Cases and Observations.
Arr. Ul.—Medical Cases and Observations. By Caaruts
Warsurton Rices, Surgeon to the Mullaglass and Cam-
lough Dispensaries.
CONTRACTION OF THE CHEST, CONSEQUENT ON PLEURITIC INFLAM-~
; MATION.
SamugL Wurtz, aged 27, became a patient at the Mullaglass
dispensary on the 28th of March last, presenting the following
symptoms :—much emaciation ; expression of countenance anx1-
ous; breathing hurried, frequent slight cough, with trifling
mucous expectoration; voice weak, and articulation abrupt..
Pulse 110, small, but firm; skin hotter than natural ; perspires
freely on the breast and forehead towards morning; bowels
pretty regular. Cannot lie on the right side; sleeps badly,
and often awakes agitated by alarming dreams ; appetite much
impaired. Left side of thorax dull throughout on percussion ;
this- was rendered peculiarly evident from the opposite side.
affording an unusually clear resonance; expansion of the: af,
fected side hardly perceptible, that of the other proportionably.
augmented. The stethoscopic signs were absence of the vesi-
cular murmur, except over the subclavian, acromial and upper
scapular regions, where it was heard feebly ; that on the sound
side very loud, much more so than I had previously heard it
under any circumstances of age or disease. Heart’s action
visible at the apex, which occupies nearly the natural position,
and its impulse audible over the greater extent of the diseased
side. The account he gave of his illness was, that on the 12th
of January last, when overheated and fatigued, he cooled
suddenly, but experienced slight bad effects; after three
days he again underwent much exertion, was overheated, and
again allowed himself to cool incautiously. In the course of
that night he was seized with acute lancinating pain under
the left mamma ; the stitch he describes as having been most
Mr. Riggs’ Medical Cases and Observations. 13
intense. Heated salt, which is usually resorted to by the
common people in this part of the country under similar emer-
gencies, was applied to the side, and in two days from the be-
ginning of the more violent attack, he was almost as instanta-
neously relieved. The subsidence of the pain was immediately
preceded by a sensation of something giving way within the
chest. For two days prior to the urgent seizure, there was,
he states, an indistinct pain, or rather uneasiness on either
side of the lower part of the sternum, unattended by any consi-
derable febrile disturbance. This feeling continued, in some
degree, up to the period at which he came under my observa
tion, and was that to which he referred me for the cause of his
ill health. He was pertinacious in attributing the seat of this
disease to that situation, and of ascribing all his other symp-
toms as originating in the cause of the uneasiness there. He
had been treated for a gastric affection, had applied a blister
to the epigastrium, and used other remedies without experi-
encing any benefit. ‘The history and symptoms, general and
local, were characteristic of effusion into the left pleura ; and
the following stethoscopic phenomenon, elicited by the effect of
position and gravitation on the effused fluid appeared to fur-
nish a positive confirmatory indication. On exploring the upper
scapular region, immediately after his having reclined back-
wards, respiration was inaudible ; but after the position forward
had been maintained for some time a faint murmur was appreci-
able. I repeated the examination of this fact several times;
with the same result from each trial. He was put on the use
of blue pill in small doses, conjoined with squills, and had
a blister applied to the side. There was an unequivocal
amendment i a week ; he could lie with ease on the unaffected
side. Pulmonary irritation nearly gone, the cough and expecto-
ration having almost ceased. Pulse 100; gums slightly tender.
This treatment was continued with certain modifications, the
fluid undergoing progressive absorption, which failed, however,
to restore the sound on percussion, or that of respiration, and a
14 Mr. Riggs’ Medical Cases and Observations.
new feature, that of contraction of ‘the chest, was observed to
be developed, becoming marked in an exact ratio to the ab-
sorption. As there has been no variation in the condition of
the chest for the last two months, I look upon the deformity
as having reached the limits to which this rare and obscure
form of disease extends, and presenting those distinctive charac-
ters of this peculiar sequence of pleurisy as prominently at pre-
sent as can be expected at any subsequent period of the person’s
life. The diseased side is found, on admeasurement, to have
shrunk three-fourths of an inch. On inspecting the motions of
the chest, those of the left side have almost ceased. ‘There is
very slight, if any, elevation during inspiration, and consequently
no depression accompanying expiration, whilst, as would be an-
ticipated, on the healthy side these motions are increased : there
is heaving resembling the breathing of an asthmatic person ;
the muscles of respiration seem, as it were, to aid the lung in
the execution of its double function. In a state of quietude
the inspirations amount to twenty-four in the minute; but the
the slightest effort, even that of ‘speaking, produces marked
acceleration. ‘The posterior costa of the scapula projects from
the flattening of the side, which withdraws the natural support
from that bone, and which, for obvious reasons, occurs most
anteriorly, or towards the inferior costa. Respiration is faintly
audible under the clavicle, gradually diminishing to the inter-
costal space between the third and fourth ribs, where it ceases
to be heard. In'the upper part of the back it exists to about
the same extent, and in the same degree. ‘The sound on per-
cussion presents similar gradations ; the dulness increasing from
above downwards. .
I shall now offer a few observations on the pathology
of this affection, and in these I will be ‘chiefly guided by the
researches and opinions contained in Laennec’s work, referring
the symptoms that were present at the invasion, and during the
progress of the case under consideration, to the facts and prin-
ciples deduced by that author, and attempting an analogical
Mr. Riggs’ Medical Cases and Observations. 15,
Inquiry to ascertain, by rational inferences, in what degree his
conclusions will tend to illustrate the phenomena that were
manifested in the foregoing case.. On reviewing the symptoms,
I think it may be inferred from the undefined uneasiness expe-
rienced at the lower part of the sternum, and the general indis-
position, supervening on fatigue, and sudden cooling, that in-
flammation in a latent form existed previous to the invasion of
the acute pain, and that the violent pair indicated an intense
augmentation of the inflammatory action ; and also that the
instantaneous subsidence of the pain, and consequently the
abatement of the high degree of inflammation may be attri-
buted to sanguineous, or sero-sanguineous effusion ; or, according
to the pathological nomenclature of Laennec, acute hemorrha-
gic pleurisy arose during an attack of latent pleurisy. The
sudden cessation of pain, and the subsequent condition of the
patient, authorize, I think, the opinion that an internal hemor-
rhage occurred, which controlled the inflammation, as ob-
servation proves it may do. ‘There exists a diversity of opi-
nion as to the cause of the more complete forms of contrac-
tion of the chest. Laennec conceived that hemorrhagic pleu-
risy could alone give origin to it, whilst other pathologists,
doubting the propriety of limiting the production of the affec-
tion to a single form of disease, have assigned other states of
disease within the thorax, as contributing to, or occasioning its
formation. Laennec ascribes the production of the deformity
to the transformation of the pleural envelope into a fibrous or
cartilagmous membrane, retaining permanently the compressed
lung; and, therefore, as the absorption advances, the chest re-
cedes ; and, finally, when the absorption is complete, and the
costal and pulmonic surfaces are in apposition, or rather their
adventitious membranes are approximated, they become, by an
ulterior process, agglutinated. I think it will appear pretty
evident, that in this case, from the time of the attack till he
was put under treatment for the affection, very slight, if any,
16 Mr. Riggs’ Medical Cases and Observations.
absorption of the effusion had taken place ; and during this, a
period of more than two months, the lung was compressed in a
very considerable degree. Whether the non-expansion of the
lung was owing to the duration of the compression, or its hav-
ing an adventitious inelastic investment, binding it down, and
preventing its expansion, must remain undecided. Perhaps
both causes conspired to produce the effect, and that either
singly would be insufficient to account for its production.
This conclusion is perhaps justified by considering that it
may not be invariably the result of hemorrhagic pleurisy,
and the consequent formation of the fibrous, or fibro-carti-
laginous covering, but may arise from other morbid conditions,
the exact characters of which remain to be determined by
pathological inquirers. A subject with this deformity was
brought for dissection to the anatomical rooms in Trinity Col-
lege some years ago; I was then a student at that school, and
shall never cease to regret the opportunity I then lost of having
this morbid condition inspected. The body was that of a lad
about puberty ; on the left side of the chest, the lung was shrivel-
led to the size of a very small clenched hand, invested by a thin,
but compact membrane, of a bluish white colour, glistening,
and bearing a close similitude to the tunica albuginea of the
testis. It did not adhere at any point to the costal surface.
There was no fluid in the chest, and the degeneration seemed
to have obtained for a considerable period. Here there must
have co-existed with obliteration of the lung, considerable con-
traction of the thoracic parietes; and yet one anatomical cha-
racter, which Laennec has given, the adherence of the pulmo-
nic tothe costal surface, was absent. This I can state with the
utmost certainty, as I was engaged in dissecting the body, and
was struck with the peculiar smooth and shining appearance
the surface of the contracted lung presented.
Mr. Riggs’ Medical Cases and Observations. 17
SINGULAR EFFECT FROM THE APPLICATION OF TARTARIZED
ANTIMONY.
In a paper treating of thoracic disease, it will not, I con+
ceive, be inappropriate to subjoin the particulars of a singular
growth, resulting from the application of tartarized antimony.
I have not seen any similar instance noticed ; nor has it, so far
as I could ascertain, been observed in Dublin or Edinburgh.
I am, therefore, probably right in applying the epithet sin-
gular to this production. It occurred on the breast of a man
about twenty years of age; and in its dimensions and figure
bore a pretty close resemblance to the expanded hand of a
labourer: it was of uniform thickness, from eight to ten lines,
very irregular on its circumference, occupying the centre of the
sternum, and extending laterally over the sternal portions of
the cartilages of the ribs, with which it seemed firmly incorpo-
rated, being altogether immoveable. The surface of the tu-
mour had a shining hue, and a constricted tense aspect, very
like the skin on a cicatrix of some months’ duration. Minute,
tortuous, but very distinct vessels were seen through the inte-
guments covering it. It was dense, firm, and unyielding,
and possessed all the physical characters of cartilage. It
was devoid of sensation, and the compression, or rubbing of
the fingers, gave no pain, nor any feeling but that im-
parted to the skin. The man said it was intensely itchy
when his surface was heated ; but that, and the annoyance
from the bulk, were the only inconveniences it occasioned.
At the time at which this description was taken it had existed
nine months. Mr. Wilson, a distinguished surgeon, who has
since retired from professional life, saw it at the same period.
The tumour was produced by the hasty and indiscriminate in-
unction of tartar emetic ointment, the circumstances of which
were thus related by the man:—he had obtained a box of the
ointment from a young man in the neighbourhood, a phthisical
VOL. V. No. 13. D
18 Mr. Riges’ Medical Cases and Observations.
patient, with directions to apply it night and morning, as he
had himself done until the pustular inflammation was excited,
to remove a catarrhal affection, with a high encomium, and
promise of immediate efficacy. Instead of conforming to the
directions, he rubbed the ointment in after very short periods,
as that of one or two hours, until the eruption appeared, and
then continued the application indiscriminately over the in-
flamed ‘and suppurating pustules, until an intense general
inflammation arose, the pain and tumefaction of which forced
him to desist. No means were used to allay this violent action ;
extensive suppuration and separation of the part ensued, fol-
lowed by the gradual generation of the growth described.
The nature and cause of this formation appear simple and ex-
plicable, by attending to the physiological fact, that however
identical the primary effect of inflammation may be in the dif-
ferent tissues, and on the various surfaces in the body, there is
a tendency to transformation or assimilation of the adventitious
formation to a structure similar to that by which it was fur-
nished. This is exemplified, for instance, in inflammation of
the serous, mucous, and cellular membranes, each of which,
under inflammation, secretes fibrine, which finally assumes the
organization of the tissue that produced it. The result of in-
flammation of the periosteum, as observable in cases of one
species of node, and the state of the texture that exists in the
progress of exostosis, so ably described by Professor Macartney,
may be adduced as bearing on this principle, and as serving
especially to explain the subject under consideration. It may,
I think, be assumed, that the tumour was occasioned by the
inflammation having been communicated to the perichondrium
and periosteum, giving rise to a gelatinous exudation, which
gradually increasing, and acquiring a concrete form, ultimately
attained the cartilaginous consistence.
Dr. Evanson’s Case of Foreign Body in the Trachea. 19
Art. [V.—Report of a Case in which a Foreign Body was sup-
posed to be present in the Trachea. By Ricuarp T. Evan-
son, M. D., Lecturer on the Materia Medica at the School of
Anatomy, Medicine, and Surgery, Park-street, and one of
the Medical Attendants at the Institution for Diseases of
Children. |
(Read before the Surgical Society of Ireland.)
In the month of August, 1832, Mary Brown, an infant, one
year and one month old, was brought to the Institution
for the Diseases of Children. The countenance expressed
great uneasiness. ‘The face was pale and swollen ; and when
I first saw the child, it had one of the hands applied to the
throat, as if to indicate the seat of distress. Ona nearer ap-
proach I was struck by the peculiarity of the breathing ; respira-
tion was difficult, and a stridulous sound on inspiration, suggest-
ed the idea of croup; but this idea was at once abandoned,
being supported neither by the peculiarities of the symptoms,
nor the history of the case.
On closer examination, the child was found to be hot, rest-
less, and uneasy, and the pulse rapid. Expiration was short,
but not impeded, nor accompanied by any peculiar sound.
Inspiration, on the contrary, was long, forced, and difficult,
and accompanied by a rough, rather stridulous sound. The
child was hoarse ; and on looking into the mouth, the tonsils
were found enlarged, and the back of the pharynx inflamed.
No fit of coughing occurred during the examination ; but the
mother stated that the child was subject to severe fits of
coughing, which, however, from her description, did not seem
to resemble the cough of croup. ‘The throat appeared swelled
externally, more so than the face; and the hand continued
often to be applied to the trachea as if uneasiness were felt
there. The cry, though hoarse, became clear when the child
screamed aloud. Bronchitis of the right lung was indicated on
applying the stethescope.
20 Dr. Evanson’s Case of Foreign Body in the Trachea.
It was evident from the symptoms that the trachea was the
seat of disease, but it was not a case of croup: what then was
it? To the history of the case we were to look to deter-
mine the diagnosis. I suspected the presence of a foreign
body in the trachea, and inquired if the child could have
swallowed any thing likely to stick in its throat ; when it ap-
peared that up to Friday previous to the day (Tuesday) on
which the child was presented at the institution, it had enjoyed
perfect health. While its parents were at dinner on I'riday,
the child, who was present, caught hold of some herring,
which it forced into its mouth. Immediately, it was seized
with a violent fit of coughing, and threw out what it had
attempted to swallow, pointing to the ground where it fell.
This was carefully examined, but no bone could be detect-
ed. The child continued to cough violently, and the mother
tried to force down with her finger whatever might be sticking
in the throat. On withdrawing her finger, the child appeared
to become hoarse. To this violence may be attributed the
inflammation of the tonsils and pharynx.
The child passed a sleepless night, coughing and _ hoarse.
On the next morning, the peculiar stridulous breathing (already.
noticed) was perceived, from which we may infer it to have
been the consequence of inflammatory action set up during the
night. Castor oil was administered by the mother, we need
hardly add, without any benefit to the symptoms, which becom-
ing each day more severe and constant, the child was brought
to the Institution on the Tuesday following ; the fourth day af-
ter the accident, previous to which the child had been in per-
fectly good health.
After hearing the history just detailed, little doubt was left
on my mind, that the cause of the child’s sufferings was the
presence of a foreign body in the trachea ; most probably a
bone of the fish which the child had attempted to swallow.
The particular character of such a foreign body, sharp and ad-
herent, and calculated to cause inflammation in the mucous
membrane of the trachea, would account for the peculiarity of
Dr. Evanson’s Case of Foreign Body in the Trachea. 21
some of the symptoms, differing from those more commonly ac-
companying foreign bodies in the windpipe, especially such as
are smooth and moveable.
The usual stethoscopic signs of alternate freedom or ob-
struction to respiration were absent; and a sound subsequently
heard, as if indicating the movement of a smooth body up
and down the trachea, was found to depend on the passage
of bubbles of air, caused by respiration in the mucous secre-
tion, with which the trachea became ultimately loaded. The
constancy of the stridulous sound in respiration indicated
the inflamed state of the mucous membrane, which could not
fail to have been induced by the injury consequent on the pre-
sence of a sharp and wounding body, and this view was con-
firmed by the fact of this peculiar sound not having been heard
until the morning after the accident, when there had been time
for the occurrence of inflammation. This sound, though resem-
bling that of respiration in croup, yet formed the only point of
_resemblance ; the cry being quite clear when the child screamed
aloud; and the character of the cough being materially diffe-
rent ; neither indeed did the cough resemble that commonly
attendant on the presence of a foreign body, it did not:take
place in sudden and violent paroxysms, with comparatively com-
plete tranquillity between, but was more of a harassing, teazing
kind, though occasionally in a severe fit enough. The pecu-
liarity moreover of the difficulty of breathing taking place du-
ring inspiration, and not expiration, made a difference between
the symptoms of the present case and those usually observed ;
especially when the foreign body is round and smooth; but the
foreign body in this case (if any) was sharp, angular, and likely
to remain fixed ; while the history of the case lett. little doubt
that a foreign body had been ‘swallowed, and what that foreign
body was.
After this statement, the case may appear clear enough, but
when first presented, and before the history and symptoms
could be thus collected and collated, it will be conceded that
22 Dr. Evanson’s Case of Foreign Body in the Trachea.
the case was one of some difficulty, if not doubt. Under these
circumstances, and feeling that operation would most probably
become necessary, I had the child brought to Mr. Crampton,
consulting surgeon to the Institution, who examined the case
with much care. He passed a bougie to remove the possibi-
bility of any substance adhering in the cesophagus; when
strangely enough, the child was found to experience immediate
relief, the breathing having become freer and more easy. ‘This
amendment, however, was but temporary, the former symptoms
quickly recurring. As the child did not appear in any imme-
diate danger, and some of the symptoms at least, were to be
attributed to inflammation, it was determined to try the effect of
active antiphlogistic treatment, before recourse was had to ope-
ration, especially as the mother evinced a determined opposition
to such a proceeding. Leeches were ordered to be applied to
the throat ; and a purgative of calomel and jalap, with a strong
solution of tartar emetic, prescribed. Next day the child was
presented at the Institution, but no relief seemed to have been
experienced from the remedies employed. The leeches had
bled freely, the child had been well purged and often vomited,
but the symptoms appeared to have increased rather than to
have been mitigated, and even the bronchitis was found to have
extended ; and now occupied both lungs. The child was again
seen by Mr. Crampton, and operation immediately decided
upon, but some hours elapsed before the parents’ consent could
be obtained, or they got to bring the child to the Meath hospital,
where Mr. Crampton was to have it under his care, as at the
Institution for children accommodation for intern patients 1s not
provided. The child was now seen by several medical men,
all of whom agreed in the diagnosis already given, there being
no second opinion as to the nature of the case.
When brought to the hospital the child was found to be in
urgent danger, all the symptoms had become rapidly aggravated,
and the general strength appeared failing fast. The surface
Dr. Evanson’s Case of Foreign Body in the Trachea. 23
was cold, face somewhat livid, and eyes glassy ; no cough was
heard, but much uneasiness was apparent.
It is unnecessary to detail the steps of the operation which
was performed by Mr. Crampton; suffice it to observe, that a
little time was permitted to elapse after the external incision had
been made, to allow of the subsidence of the hemorrhage ; a
useful precaution worthy of notice. On plunging the knife into
the trachea the child screamed aloud; but after the incision
was completed, the voice was lost. The child started convul-
sively (the mouth being covered with foam) and appeared in
imminent danger of suffocation; but on the excision of the
piece of trachea being completed, relief was obtained. The
bone was carefully searched for, but could not be detected,
though an elastic bougie was passed upwards two or three
times, through the wound. The child was now restored to its
mother, and placed in bed ; no immediate or very palpable
improvement having attended on the operation, such as often
occurs in cases where foreign bodies in the trachea have been
operated for and removed; but which we are not always im-
mediately to expect, even when the body is moveable in the
passage.
On the morning after the operation*, however, some amend-
ment was manifest ; though the child still continued to suffer
much from some.of the prominent symptoms. The respiration
was laborious, stridulous, and wheezing, being seventy in a mi-
nute, while an occasional violent fit of coughing was necessary
to remove the copious secretion of thick mucus that blocked up
the opening in the trachea, which was with difficulty kept
clear. The child, however, began progressively to improve,
calomel and hippo being the only medicines administered. An
occasional fit of violent coughing, at times threatened suffo-
Mr. John Hamilton kept an accurate daily report of the progress of the case,
while in hospital, with which he has kindly furnished me.
24 Dr. Evanson’s Case of foreign Body in the Trachea.
cation, but was to be attributed to the cause already assigned—
the blocking up of the opening, with the profuse and tenacious
mucous discharge. |
On the Monday following the operation, the quantity of
this discharge was observed to be sensiby diminished: the
cough was slighter and less frequent; respiration being, better
performed through the natural passage.
The child continued to improve, and the wound, which had
much contracted, now allowed of being closed without inconve-
nience: but the cough was still occasionally very troublesome,
and assumed so much of the character of pertussis, that a mix-
ture containing carbonate of soda and opium was prescribed.
The mother now removed the child from the hospital, being
provided with this medicine. Ina few days she returned, bring-
ing with her the child, which had now nearly quite recovered.
‘The wound had completely healed, and the natural respiration
been restored ; but some cough still remained, and the voice
continued faint and hoarse, as was indicated when the child
made a noise or cried. The change of voice continued for
some time, nor was it restored to its natural sound for several
months. But it has since become quite natural, clear, full, and
Joud; while the cicatrix from the wound has contracted so
much, as to leave little or no deformity, being, in fact, hardly
perceptible.
The peculiar character which the cough had latterly as-
sumed, with the continned hoarseness and feebleness of voice,
may be, perhaps, accounted for by the irritation of the glottis,
naturally connected with the inflammatory action going on in
the upper part of the larynx ; some cases being on record, in
which the adhesion of small foreign bodies (as saw dust) to the
glottis, produced cough, very like pertussis ; while the thicken-
ing, consequent on the inflammation, would account for the
change of voice, and the resolution of that thickening, for its
restoration.
This case cannot but be regarded as interesting and impor-
Dr. Evanson’s Case of Foreign Body in the Trachea. 25
tant. That the child had been rescued from impending death,
by the operation of bronchotomy, no doubt could be enter-
tained, and this may be deemed a sufficient corroboration of
the correctness of the opinion which led to the performance of
that operation ; for had a different course been adopted, it
is but reasonable to suppose that a different result would have
taken place. Still it was unsatisfactory that no foreign body
had been found, and that neither during the operation, nor at
any time subsequently, was the bone detected, though anxiously
looked for by the medical attendants. Undoubtedly we may
suppose that the bone, though present, might have easily es-
caped amid the quantity of mucus that was expelled both by
the mouth and through the artificial opening, and so have eluded
detection. But still it was dissatisfactory that we should want
this unequivocal proof of the correctness of our practice, though
this by no means impeached the fact, that by that practice the
child was saved.
But even this source of dissatisfaction is removed, if we may
rely on the statement made by the child’s mother, and which re-
lieves the history of the case from all imperfection ;—if, indeed,
it is to be relied upon: for this, however, T cannot vouch ; but
I feel called on to state what I have been told.
On going some days after the child’s removal from the
hospital, to inquire after it, I stated my surprise that no bone
had been found, when I observed a look pass between the
parents, which made me suspect some concealment, and I im-
mediately charged the mother with deception. She then con-
fessed that she had herself extracted the bone, but had con-
cealed it; at first, through fear that farther operation might have
been resorted to, and subsequently through dread of censure,
for having herself meddled, and then concealed what she had
done. She produced a portion of fish bone, which she had
carefully wrapped up in paper, and which she stated to be
but part of what she had originally found; another portion
broke off and was lost’ while I was examining it, so that the
VOL. Vv. NO. 13. E
26. Dr. Evanson’s Case of Foreign Body in the Trachea.
fragment which I was able to preserve, is but a small part of
the bone originally found. This appears to be part of the
bone of a herring, or other small fish, and was of its usual co-
lour, though somewhat less firm than natural, when I obtained it.
The woman’s story is this; on the fourth night, after operation,
she thought she felt something hard stick in the sponge with
which she was clearing away the mucus from the wound. A
projecting point now began to appear whenever the child
coughed, and the direction of this body seemed to be from the
upper part and side of the wound. She assigns, as her reason
for not informing some of the medical attendants of this fact, her
dread that another operation would be resorted to for the ex-
traction of this body. It projected so much before morning,
that she was induced, herself, to attempt its removal, which she
accordingly effected, but not without being obliged to use some
force, and a small quantity of bloody matter followed, with
which, also, the extremity of the bone was stained—this extre-
mity, which she pointed out, being sharp and hooked. When
removed, she states the bone to have been soft, and of a green-
ish colour, like that of the mucus expectorated. On putting it
into some whey to steep, this colour disappeared, and the bone
lost its softness on drying. She says that she intended to have
told me this when she saw me, which did not occur until my
visit to her house, and then she made the statements I have
mentioned. One circumstance she distinctly dwelt upon, that
the child was found better next day, and breathed more freely
through the mouth. This statement I find corroborated accord-
ing to date in Mr. Hamilton’s report, who, at the time, knew
nothing of the woman’s story, and does not, I believe, now cre-
dit it, though he expresses no doubt that a foreign body had
been present in the trachea. I do not enter into any discussion
as to the probability of the woman’s statement ; I rather incline
myself to believe it: but though its veracity would render more
satisfactory the result of the case, as leaving nothing to conjec-
ture, it is by no means essential to establish the correctness of
the diagnosis or practice.
Dr. Evanson’s Case of Foreign Body in the Trachea. 27
AA striking and unexpected corroboration of the correctness
of both, is derived from the details of the following case, most
curiously similar in its history and symptoms, though far diffe-
rent in its result; for the particulars of which I am indebted
to my friend Dr. Maunsel.
A healthy child, about two years old, was suddenly seized
with a paroxysm of coughing, followed by stridulous breathing,
and so much dyspnoea, as appeared to threaten instant suffoca-
cation. ‘The case was treated by a medical man as one of croup,
which, in fact, it closely resembled. Relief appeared to follow
the treatment, but similar paroxysms recurred from day to day,
and became on each repetition more alarming. About ten days
after the first attack, Dr. M. saw the child in the absence of the
medical attendant. It was much debilitated; the breathing
remained permanently stridulous, and paroxysms threatening
suilocation, followed upon the least excitement. As the pro-
traction of the disease threw doubt upon the supposition ori-
_ ginally entertained of its nature, a more accurate inquiry was
instituted respecting the circumstances attending its commence
ment ; when it was discovered, that at the moment of the first
seizure, the child had been sitting upon the knee of one of the
servants, while the latter was dining upon fish. From a consi-
deration of these circumstances, Dr. M. imagined that the
symptoms might probably be accounted for by the presence of a
portion of fish bone in the trachea, and suggested the perfor-
mance of bronchotomy. As the case was enveloped in a good
deal of obscurity, the operation was not, at first, acceded to.
Eventually, however, it was performed, about three weeks after
the accident, but the child was so much weakened, that it ex-
pired immediately after the operation. A portion of herring
bone was found lodged in the ventricle of the larynx.
From the history and result of this case, we derive a most
instructive corroboration of the justness of the views entertained
respecting the preceding one, and almost cease to feel any con-
cern as to whether the statement of the bone having been dis-
covered in that instance be true or not. Atall events, the history
28 Dr. Evanson’s Case of Foreign Body in the Trachea.
of these cases establishes, that the occurrence of a foreign body
in the trachea of aninfant, leading to symptoms closely simulating
those of croup, and capable of being confounded with it, is not
an isolated fact. We have hence a salutary warning (if such in-
deed be wanting) of the necessity for the most scrupulous ex-
actness in investigating cases of disease oceurring in infants,
who are themselves unable to afford us any clue as to the
nature of their sufferings, while those around them are but too
often interested in deceiving and misleading us, in order to con-
ceal their own neglect or mismanagement.
When called upon, then, to treat a case of croup, (for every
affection of the throat, accompanied by any wheezing sound, is
so called by the attendants ofan infant,) we may bear in mind
the possibility of a cause for the symptoms present, far different
from what may have been suspected, and the consequent neces-
sity for timely recourse to operation.
Far be it from me to wish to inculcate or induce a hasty
recourse to such a proceeding, or to represent bronchotomy in
the infant, as a trifling or even easy operation, such as it ap-
pears to be when performed on the still, attenuated subject.
No one who has witnessed its performance in the living infant,
beset as it is with difficulties and dangers ;—the short neck, nu-
merous blood-vessels, narrow, deep-seated windpipe, in frequent
or convulsive motion,—can fora moment think lightly of this
operation, or feel inclined, heedlessly, to undertake it. Yet we
have just seen two cases, in which its performance became unex-
pectedly necessary, and in one of which, its timely aid seemed to
avoid impending dissolution ; while in the other, its undue pro-
crastination hastened a death, which its earlier employment
might, most probably, have prevented.
From these cases, also, we may glean a few points of general
practical interest. We see that the irritation of a sharp foreign
body in the trachea of a child, leads to an inflammation of
its mucous membrane, ultimately extending over the whole
bronchial tubes, accompanied by copious mucous or purulent
secretion, and attended by stridulous breathing, much re-
Mr. Collis’ Cases of Popliteal Aneurism. 29
sembling croup; but not (it would appear) leading to the
formation of the false membrane, so peculiarly characteristic
of that disease. Had the foreign body been even coughed up,
the resulting inflammation might still render the case subject
for operation, like those instances in which croupy symptoms
are induced by the inflammation of the larynx or upper part
of the trachea, consequent on the irritation caused by the
swallowing of vitriolic acid, or boiling water: and it is in such
cases, before the inflammation has extended downwards, that
bronchotomy is so serviceable, by affording the means of respi-
ration, until the inflammation that obstructed the natural passage
has subsided, or been subdued. Under such circumstances, re-
lief is afforded by timely opening of the trachea, even though
the foreign body, when such is the cause, be not removed, but
this we may at least suppose capable of escaping or being re-
moved from the opening several days after it has been made.
Whether such a result is to be looked for, or may be at-
tempted to be brought about by instruments, when the foreign
body is situated lower down in one of the bronchi, is a question
of great importance, but of ulterior research, which I do not
now venture to enter upon. It has already received attention
from Dr. Brown, in an elaborate essay published by him in the
Edinburgh Medical and Surgical Journal; and I doubt not
will derive farther illustration from the pen of Dr. Houston, in
the very curious and interesting case, contained in this number.
i Se et
Art. VI.—Two Cases of Popliteal Aneurism. By Maurice
Conus, A.M., one of the Surgeons to the Meath Hos-
pital.
Cast I.— Double Popliteal Aneurism, of fifteen years’ stand-
ing. The right Aneurism becoming diffuse from injury.
Ligature of both Femoral Arteries. Recovery.
November 1, 1833. James Brady, et. 38 years, a strong,
healthy man; formerly an infantry soldier, and consequently
30 Mr. Collis’ Cases of Popliteal Aneurism.
exposed at times to violent and fatiguing exercise. In the
year 1818 (without having received any injury of which he was
aware) he felt a pain in both hams, and soon after perceived
a tumour in each popliteal space. ‘These became somewhat
larger when exposed to fatigue or cold; from the commence-
ment a throbbing was felt in the tumours, but the patient was
never prevented from attending to the duties of his occupation,
These tumours continued stationary until August, 1833, when
his right leg was much and severely bruised between two cows,
(he was at this time employed as a cattle driver). ‘The tumour,
in this limb, shortly after increased and became painful ; the
throbbing augmented. The leg and thigh became swollen,
and the foot numb and cold.
He came to the Meath Hospital in this state about six
weeks ago, and as he refused to remain in the house at that
time, I directed a cold evaporating lotion to be kept on for
some time, and subsequently a moderately tight roller ; under
this plan the swelling diminished and the pain abated. He
shortly after resumed his labours, and exercised his limbs con-
siderably, and in consequence, the tumour began again to
increase. His leg and foot became swollen and cedematous,
and he complained of numbness, and a want of sensibility im
the limb. The tumour in the ham became more diffused ; and
the pain, and an uneasy sense of constriction in the limb
deprived him totally of rest. At this period there was no
alteration in the aneurism of the left limb. In this state he was
admitted into the hospital; the veins upon the surface of the
limb were very distinct, and the saphena particularly promi-
nent. There was a slight erysipelatous blush over the inside
of the knee. Pulsation much diffused over the tumour. Pulse
90, rather hard; tongue clean; bowels regular. His general
health was but little affected. There was not the slightest evi-
dence of other disease in the remainder of the arterial system.
He never suffered from palpitation of the heart, or difficulty of
Mr. Collis’ Cases of Popliteal Aneurism. 3h
breathing. He was placed in bed, kept quiet, allowed mode-
rate diet ; some purgatives, and an opiate at bed-time, and a
cooling evaporating lotion to the swelling. The pain dimi-
nished, and the external inflammation subsided; but the tu-
mour became daily more tense and extended: so that upon
consultation it was determined to tie the right femoral artery,
as the limb, as well as his life, became more and more en-
dangered. I performed the operation on the morning of the
10th. The vessel was tied in the upper third of the thigh,
with a single round ligature, consisting of three threads of
three-corded silk. The patient did not lose a spoonful of.
blood in the operation. This case proceeded favourably, and
the ligature separated upon the seventeenth day. From the pe-
riod ofits application the tumour gradually diminished, and the
swelling of the leg entirely disappeared.
December 3. Able to walk about a little. The surface of
the tumour is soft, and gives a slight sensation of fluctuation.
It will, in all probability, suppurate before the patient gets
quite well. |
On the 14th, I tied the left femoral. In endeavouring to
separate the artery from the vein, I made a small opening,
about the size of a pin’s point, into the artery, from which
a rapid jet of blood took place. The artery was immediately
compressed against the pubis, and a double ligature applied;
one part of which was tied upon the highest exposed position of
the vessel, and the other upon the lowest, leaving between
both about a quarter of an inch of the artery. He did not lose
more than about an ounce or two of blood. The tumour disap-
peared almost entirely after the application of the ligatures. The
limb retained a moderate degree of temperature ; every thing
went on favourably, and on the 27th both ligatures came away.
This man’s health is daily improving. His appetite is good,
bowels regular. He walks about every day, and is gaining
strength. The tumour in the left ham has almost entirely dis-
appeared ; that in the right is daily becoming smaller.
32 Mr. Collis’ Cases of Popliteal Aneurism.
This case presents many points of deep interest ; among
these, the following seem to me to be the most remarkable :
Ist. The great length of duration of the aneurismal tumours
without their being productive of any unpleasant effects ; they
existed almost stationary from the year 1818 to 1833. Iam
not aware of any similar case being upon record.
2d. Both tumours occurring simultaneously, a very unusual
circumstance, and the more particularly so, that there does not
appear to have been any general disease of the arterial system.
3d. The disease occurring in both situations without any
sensible injury.
4th. The little inconvenience suffered by the man; he was
never prevented from attending to his duty, which at times
must have been very laborious, until the period of his first ap-
plication to the Meath Hospital.
In this case we had to consider many circumstances before
undertaking the first operation. It was true, that the disease ex-
isted in more places than one; but the conditions under which
the patient had so long borne the disease were changed ; the
right aneurism had become diffused from injury. The limb
oedematous, and inflammation setting in. No alternative re-
- mained, but to tie the vessel, or allow the man to die of gan-
gene.
This operation having succeeded, I was encouraged to the
performance of the other by the general healthy state of the
arterial system, as shewn by the great length of time which
elapsed from the first period of disease, by the patient’s bearing
the first operation so well, and from the importance of placing
him out of the danger of an accident, such as had happened to
the right aneurismal tumour.
Case Il.—Popliteal Aneurism in a healthy subject. Opera-
tion. Copious hemorrhage from the wound on the eighth
and thirteenth days. Employment of pressure. Reco-
very.
November 8, 1832. Michael Maddock, et. 30 years; a
Mr. Collis’ Cases of Popliteal Aneurism. 38
labourer, generally very healthy ; resides in the country, about
five miles from Dublin; applied for relief this day. He has a
large pulsating tumour in the left ham, which completely fills
up the popliteal space, and which projects very much toward
the outside. The swelling is hard, smooth, and elastic ; pulsa-
tion strong ; the bruit de soufflet very distinct ; a slight blush of
redness over the most prominent part of the swelling. By
compressing the femoral artery (the action of which is very
great) all pulsation in the tumour ceases. He cannot bring
his leg into a straight position. The leg is swollen and cede-
matous, and of a mottled colour. Complains of much pain in
the ham, and numbness of the leg and foot. His pulse is
about 100; no fever ; no indication of disease of the heart, or
arterial system generally.
About five months ago he first felt pain in the ham, but did
not perceive any swelling until three months subsequently.
He continued at his work until three weeks since, when the
tumour became suddenly larger, and very painful; the limb
became much more cedematous, and he was obliged to remain
in bed. A few leeches and a cold evaporating lotion were
applied with relief.
Operation.—12th. I tied the femoral artery in the upper
third of the thigh, at the usual place. Nothing particular
occurred during the operation, excepting a little delay arising
from some difficulty which was experienced in passing the
needle around the artery, in consequence of its peculiarly close
adhesion to the vein and sheath. Upon the application of the
ligature the pulsation in the tumour immediately ceased, and
he was placed in bed, the wound being dressed as usual. In
the evening he complained of shooting pain along the back of
his leg and thigh; did not sleep. No alteration in the size of
the tumour, the apex of which is of a light purple or copper
colour.
15th. Suffered much from pain in the foot and back of the
leg. The muscles of the entire limb were occasionally thrown
VOL. V. No. 13. F
34 Mr. Collis’ Cases of Popliteal Aneurism.
into spasmodic action. A cold evaporating lotion was applied
to the ham, which gave considerable relief. The leg and foot
cedematous; the tumour feels more firm and contracted.
20th. Scarcely any alteration since the last report until
this day. Upon dressing the wound, he complained that it felt
much hotter than before, and a slight streak of blood was ob-
servable upon the dressings. About four o’clock, p. mM. he
experienced a sensation as if something gave way suddenly, and
immediately afterwards he observed blood to gush from the sides
of the wound. Before assistance could be obtained he lost, if was
calculated, about twenty-four ounces of blood. ‘Temporary
pressure with lint and the hand was applied, and I was sum-
moned to his assistance. I found the man’s bed loaded with
blood: I made an assistant compress the artery as it passes
over the pubis; I then opened the wound through its entire
length with my finger, removed all the coagula ; I then applied
a small firm compress to the bottom of the wound, which I
filled up with pieces of sponge, and over these I applied a
presse artere, with a graduated screw, which was kept very
tight until the 22d, when it was loosened, but not removed.
During this interval he was bled from the arm, purged, took
digitalis, &c.
25th. Some degree of erysipelatous inflammation having
been produced upon the upper part of the thigh, and anterior
part of the abdomen, from the pressure caused by the instru-
ment, it was removed.
27th. On this morning I took away all the sponges and
lint, which were soaked in purulent matter, and came away
without any difficulty. The wound looks healthy, and is gra-
nulating.
December 1. A small abscess formed on the upper and
outer part of the thigh where the instrument pressed.
3d. About three o’clock this day (being thirteen days
from the first attack of hemorrhage) a second took place; he
lost only a few ounces of blood, as it was immediately arrested
Mr. Collis’ Cases of Popliteal Aneurism. 5
by our intelligent apothecary, Mr. Parr, who instantly filled
the wound with sponge, and applied the screw, which was left
on until the 7th, when it and the sponges were removed.
During this period the state of the patient seemed nearly hopes
less. His countenance was almost hippocratic ; he resembled.
a person in a low stage of typhus, and a gangrenous smell ex-
haled from the body. He was freely supported by wine, bark,
and animal food. He had no further bleeding, and began to
recover rapidly. On the 4th of January he was sent home,
and soon after resumed his labours.
The instrument which I made use of was one previously
employed by Mr. Crampton, the Surgeon General, in a similar
case, and with good success. Jt consists of an iron hoop, about
an inch and a half in breadth, and sufficiently large to encom-
pass the thigh ; it opens behind, so as to admit of such dilata-
tion as to suit a limb of any dimensions. This hoop has a slit
in the anterior and internal part, into which is placed a move-
able screw, with a pad attached. This pad is to be applied
immediately over the compress, which has been put upon the
artery, and then by turning this screw, any degree of compres-
sion can be made upon the artery, whilst little or no pressure
is made upon the other parts of the limb, and consequently no
great obstruction, if any, is given to the collateral circulation.
The hoop produced much inconvenience to this man, and was
also the cause of inflammation, which terminated in abscess.
‘This arose from the instrument being too narrow upon the part
on which the limb rested, and J have now got one constructed
with a broad flat surface ; this is padded, and fits the under
and outer part of the limb accurately, and on which the thigh
rests without any inconvenience. To this are added two
straps, one to surround the pelvis, and another the thigh, by
which means the instrument is kept more firmly in its situation.*
* This instrument was made by Reynolds, of the Coombe, who has shown
much intelligence in constructing this and other instruments.
36 Dr. Joere’s Researches on Solidification of the
My chief object in recording this case is to show the advan-
tage to be derived from pressure properly made, in arresting
secondary hemorrhage, from such a vessel as the femoral ar-
tery, and the greater benefit likely to arise from such a mode
of proceeding, than from tying the artery higher up, which,
in the majority of the cases in which it has been tried, has
failed in saving the life of the patient.
Arr. VII.— Researches on Solidification of the Lungs in New-
born Infants. By Epwarp Jorre, P. D., C. M.B. Leipsig.
Tue greater number of new-born infants die of convulsions,
apoplexy, or suffocative catarrh; so, at least, we are told by
the parents, and even by the medical attendants, who are often
unable to give us any clearer account of the matter, or unwil-
ling to take the trouble of finding out a more accurate explanation
of it. And yet the sudden death, or remarkable wasting away
of so many children, should incite every observer to do his ut-
most to investigate the hidden causes of such melancholy occur-
rences. According to some experiments and observations made
in the Leipsic School of Midwifery,* the various conditions
and accidents which so frequently endanger or destroy the life
of new-born infants, depend on one and the same organic dis-
ease of the lungs, resulting from either too difficult, or too
rapid and easy a delivery. |
It appears that the infant, immediately after its expulsion
from the uterus, has to make a strong and deep inspiration, in
order at once to commence and to continue effectually the new
vital process connected with the great change in the circulation
which then takes place. Nor has nature neglected to make
* Dissertatio inauguralis pro summis in medicina et chirurgia honoribus ca-
pessendis: ‘* De morbo Pulmonum Organico, ex Respiratione Neonatorum Im-
perfecta orto ;” auctore Edvardo D. Joerg, AA. LL. M. Philos. Doctore, et Med.
Baccal. Lipsie, 1832, sumtibus Barthi.
Lungs in New-born Infants. BT
every requisite provision for this; since by the diminished vi-
tality of the membranes towards the close of pregnancy, and
the gradual compression of the placenta during parturition, the
former circulation of the foetus is obstructed, and the scarcely
born infant compelled to compensate by inspiring, for the de-
ficiency of oxygen thereby produced. The first inspirations are,
in consequence of this deficiency, (a state resembling asphyxia
by carbonic acid or other poisonous gases,) naturally the most
powerful, and at once expand the lungs to admit the rush of
blood ; so that the foramen ovale and ductus arteriosus may
close and become obliterated : in which case the child continues
to respire regularly, oxygenizes his blood, and is able to ery
and to drink.
Thus the first cry of the infant, while it indicates its anxious,
suffocating condition, serves at the same time to open and ex-
pand its lungs, and is consequently more analogous to the deep
sighing and groaning of persons taken out of cellars or caves
contaming irrespirable air, than to a real expression of pain.
Now, when any noxious influence prevents the development of
this natural condition of the lungs, and produces the opposite
one, it is evident that the consequences must be highly in-
jurious.
Two cases have been observed, in which the respiration of
new-born infants is rendered irregular, and organic disease of
the lungs produced ; namely, Ist, too difficult, and 2d, too ra-
pid and easy a delivery. The former by too great compression
of the head, and consequently of the brain, (whether in the
pelvis during violent pains, or by the forceps,) weakens the in-
fant to such a degree, that it is absolutely unable to relieve it-
self, and can only respire imperfectly, so that its lungs are but
partially distended. The condition thus produced, is precisely
similar to that to be presently described, except that in the
latter, the pressure on the brain frequently produces inflamma-
tion of that organ, and thereby renders the case more compli-
cated.
38 Dr. Joerg’s Researches on Solidification of the
2. Too rapid and easy a delivery, in consequence of its
short duration, and the inferior degree of compression of the
placenta, does not produce the requisite obstruction to the
foetal circulation, nor the due want of oxygen which makes res-
piration necessary. The consequence is, that the infant only
respires imperfectly, expands and fills its lungs with air but
partially, and is never able subsequently to remedy this without
the aid of art.
Under the circumstances above mentioned, we have often
seen infants suddenly seized with illness, and sometimes die in
spite of every exertion made to save them, before the real
cause of the attack and the proper method of treatment were
discovered ; and on examination the following appearances
were observed, arising all from the same causes, though differ-
ing greatly among themselves in many respects.
In every case in which we made a post mortem examination
for several years past, a portion only of the lungs, from the
greater half to merely an eighth or tenth part, was found filled
with air, and of a red colour; while the remaining portion con-
tinued in the same state in which it had been in the foetus, and
was of a liver colour. When the infant had died..soon after birth,
the condensed portion was susceptible of inflation; but where
death did not occur till several weeks after that event, it was
found carnified and incapable of being inflated ; sometimes the
partition between the healthy and diseased portion was in a
state of inflammation, and the latter contained vomice: the
bronchi, too, were often inflamed and filled with mucus. The
great contrast between the bright red of the healthy, and the
liver brown of the diseased portions, struck the eye imme-
diately on opening the thorax. In most cases, the foramen
ovale was still open, and there were very firm polypi in the
heart and large vessels. The brain was frequently gorged with
blood, which was sometimes even effused between its mem-
branes and over its surface: it also occasionally contained ab-
scesses corresponding to others on the cranium, or fontanelle,
Lungs in New-born Infants. 39
that had been produced by the use of instruments, or by vio-
lent pressure against the pelvis during delivery. In the rest of
‘the body, there was no particular morbid phenomenon con-
stantly present: however, in the greater number of cases, the
skin, particularly on the face, had a bluish cast ; while in some
it was withered and emaciated, and the whole body, especially
the intestines, pale and bloodless.
Krom these facts, and from observations made of late years
during the progress of the disease, we are warranted in describ-
ing its nature and terminations in the followmg manner: The
solidification, or continuation in the foetal condition of a greater
or less portion of the lungs, so that during inspiration their
substance cannot be penetrated by the air. The blood, being
still more incapable of penetrating, cannot be supplied with
oxygen, and must consequently continue venous, and produce
obstructions and dangerous congestions; while at the same
time, from its being unable to afford the stimulus requisite to
the system for the continuation of its functions, an atonic senile
condition obtains, attended with the utmost weakness, and com-
plete atrophy, and terminating in death in hectic fever. The
general morbid condition is, consequently, difficulty of respira-
tion and impeded circulation, producing dangerous and even
fatal congestions. Its terminations are: Ist, recovery; 2d, se-
condary diseases ; and 3d, death.
I. Recovery ensues when the efforts of the infant to inspire
are assisted by proper treatment, and the subsequent symptoms
properly managed.
Il. Secondary diseases :—(a) obstruction of the lungs, inas-
much as a portion of them remains condensed, which, without
actually producing death, is very oppressive and dangerous :
(6) chronic cyanosis, the foramen ovale continuing open, and
the infant being lable to constant suffering.
Ill. Death :—(a) from apoplexy; in consequence of ob-
struction and congestion: (5) from suffocative catarrh, when the
feeble respiration is not able to expel the mucus secreted in
40 Dr. Joerg’s Researches on Solidification of the
the bronchi, and the violent efforts at full inspiration produce
bronchitis, and an over-abundant secretion of mucus, which the
patient has not strength to get rid of: (c) from fever, the result
of bronchitis: (d) from atrophy ; the production of animal heat
being prevented by the deficiency of oxygen, and the whole sys-
tem paralyzed by the want of its requisite stimulus.
Symproms.—When the infant comes into the world, the
head is either found greatly swollen, (in which case abscesses
often form in the part that has suffered from pressure, and in-
flammation or violent congestion of the brain ensues,) or else,
though quite uninjured, and the delivery having been rapid
and easy, it cries but feebly, breathes very short, and exerts
the muscles of the thorax greatly ; it is presently attacked with
a faintness, and if it had been capable of drinking previously,
now loses that power, the voice becomes hoarse and weak, and
scarcely audible. Stertor and convulsions soon follow, the
little patient becomes quite blue, the eye-balls turn, and the
respiration remits, sometimes for so long as five minutes, till
the scene at last closes with death. Should the illness continue
for some days or weeks, a little short cough, the most certain
sien of violent bronchitis, comes on; together with total weak-
ness, atrophy, and hectic fever; and the child, at the very
latest four or five weeks after birth, sinks under a violent attack
of cyanosis, or bronchitis, or from the effects of the fever and
atrophy.
The best method of preventing the organic disease of the
lungs is, Ist, on no account to hasten the birth unnecessarily,
because this never can be done without endangering the child ;
and 2d, as far as possible to prevent too violent pressure on the
head. The respiration of the new-born infant should be accu-
rately observed, and the strength of its voice and manner of
sucking attended to; and the moment we find the breathing
too short, or the voice hoarse or feeble, and plaintive, or that
the infant cannot suck properly, we must immediately exert
ourselves to set matters to rights. In the first place, the me-
Lungs in New-born Infants. 41
dical attendant should immediately endeavour to blow air into
the lungs, till the thorax is properly expanded. The navel-
string must not be cut too soon ; the chest and back should be
stimulated by friction with the hand ora brush; they might
also be sprinkled with cold water and sulphuric ether, and the
soles of the feet well rubbed with a flesh brush. The child
should be put in a warm bath, and the friction continued till it
is able to cry loud and breathe properly: should these means
not succeed, recourse must be had to internal remedies. An
emetic consisting of a few grains of ipecacuanha, a drachm of
oxymel of squills, or a quarter or third of a grain of emetic
tartar, should be immediately exhibited. Afterwards a quarter,
or, In urgent cases, half a grain of calomel should be given, for
the purpose of producing general excitement by stimulating
the intestinal canal, as well as of diminishing the too copious
secretion of mucus in the bronchi, and diminishing the cere-
bral congestion. The repeated employment of warm baths,
either simple, aromatic, (by the addition of thyme or marjoram,
and calamus aromaticus,) or restorative, (composed of milk or
some mucilaginous fluid,) contributes greatly to revive the sys-
tem, and restore and promote the circulation. Simapisms of
about an inch in diameter are occasionally to be applied to the
chest or neck. ‘The most unwearied attention is requisite to
restore and maintain the health of the little patient. By the
proper application of the above remedies, by avoiding all the
ledentia, and even by delaying as much as possible every birth
that appears to be proceeding too rapidly, a great many lives
may be saved: still the disease is a dangerous one from the
very first, and requires great care and watchfulness through-
out.*
* We beg to acknowledge our obligations to Dr. West, for his translation
from the German of this original memoir. —Ep.
VOL. Vv. No. 13. G
42 Dr. Houston’s Case of a Tooth in the Trachea.
Art. VIII.—A Case in which a large Molar Tooth entered
and passed through the Larynx during the Operation of
Extraction. By John Houston, M.D. M.R.I.A., Demon-
strator of Anatomy in the Royal College of Surgeons in Ire-
land. Surgeon to Baggot-street Surgical Hospital, &c. &c.
(Read before the Surgical Society of Ireland.)
Joun Crare, etat. twenty-nine, a servant of the Rev. Mr.
Brownrigg, of temperate habits and good constitution, had occa-
sion, in the month of May, 1830, to get the second molar tooth
of the right upper jaw extracted. On the first application of
the instrument to the tooth, a fragment of the crown was
chipped off, and removed from the mouth by the operator.
By a second attempt, the tooth was started from its socket ; but
on being loosened from the claw of the instrument, it suddenly
passed down the throat, and was not seen afterwards by either
the patient or the operator. Owing to the large size and firm
hold of the tooth in the jaw bone, considerable dexterity and
force were found necessary for its extraction.
I saw the man about four hours after the operation, when
he presented me with the fragment which had been broken off
in the first attempt, and gave me the following account of the
sensations experienced at the time of the accident, and after its
occurrence. He felt at the instant on which the extraction was
completed, a momentary, sharp, prickling pain at the top of the
windpipe. This was instantly followed by a severe fit of cough-
ing, which soon went off, but recurred again several times with-
out any evident cause, and at each time with less and less seve-
rity, until, after a few hours it ceased to produce any further
annoyance. ‘The man stated most positively, that he had not, for
a considerable time previously to the accident, been subject to any
cough, or other affection of the chest ; and that at the mstant of
its occurrence, both he and the dentist attributed the sudden ac-
cession of the symptoms, to the passage of the bone down his
Dr. Houston’s Case of a Tooth in the Trachea. 43
throat. He complained, also, that from the time of the perform-
ance of the operation, he could not get rid of a feeling of unde-
finable uneasiness in the chest ; a sensation of weight in breath-
ing ; anda tendency to draw heavy sighs, which haunted and
which kept his mind in a continual state of inquietude. Occa-
sionally, but not at any regular intervals, he coughed up a little
frothy mucus, perfectly untinged with blood or purulent matter.
He had no hoarseness, no acceleration of breathing though he had
walked nearly two miles, no pain in any part of his chest, and
no relative difference in the facility with which he inspired, or
breathed out the air.
In a consultation with several eminent professional gentle-
men, held on him twenty-four hours after the accident, his con-
dition was found to be the same as that just described, and the
following stethoscopic signs were noted down: there was a mu-
cous rattle in the lower part of the trachea, audible even to the
naked ear, but very distinct when heard through the stethoscope.
Both sides of the chest gave a perfectly and equally clear sound
on percussion ; but notwithstanding their similarity in this re-
spect, there was a marked difference in the intensity of the res-
piratory murmur—the sound of the air entering into, and
expanding the right lung, being obviously more feeble than that
heard at the same moment in the left. ‘There was, likewise,
under the right clavicle a slight sonorous rale, a deviation from
the natural sound of breathing not discoverable in any part of
the left lung. These signs were fixed and not modified or re-
moved by any alteration in the position of the body; nor by
causing the patient to expire with violence, or to take a full
breath. In the consultation, various opinions were delivered
respecting the course of the tooth, viz. whether it had entered
the trachea, or passed into the cesophagus. Some gentlemen,
whose faith in stethoscopic signs were not, at that time,
(now nearly four years ago,) so strong as it has become since,
placing little weight on that part of the investigation, and rely-
ing solely on other symptoms, could not bring themselves to
AA Dr. Houston’s Case of a Tooth in the Trachea.
believe, that a large, splintered, and doubly fanged. tooth,
could find so easy an entrance through the rima glottidis, and lie
in the trachea, or bronchial tube, without causing distress of a
more urgent nature, than that complained of by the patient ;
seeing that so small a body as even a cherry stone, can produce
so much disturbance there. The fit of coughing, induced at
the moment of the accident, might, in their opinion, have been
caused by a scratch of the tooth on the epiglottis, while passing
through the pharynx into the cesophagus ; and it was considered
that the transient existence of this symptom, gave confirmation
to such a view of the matter. Then, as to the feeling of uneasi-
ness, and tendency to draw heavy sighs which the man com-
plained of, they were accounted for by supposing them to have
arisen more from the alarm produced by the marked attention
paid to the patient, on account of the singularity of the accident,
than from any serious injury he had sustained.
On the other hand, it was urged by those present who
happened to be greater believers in the value of the stethoscope,
that the fact of the respiratory murmur being feeble and indis-
tinct in the right lung, whilst the sound on percussion thereon
was equal to that produced by striking over the left, taken in
connexion with the rattle in the lower part of the trachea and
top of the right lung, indicated the existence of an obstructing
body in the right bronchus. ‘They were ready, however, to
admit, that of these symptoms, no single one, nor indeed all
taken together, could, of themselves be considered unequivocal
evidence of the presence of the tooth in that situation; but,
when viewed in conjunction with the other immediate conse-
quences resulting from the operation, in an individual, too, pre-
viously in good health, viz. the sudden and certain disappear-
ance of the tooth; the violent fit of coughing which occurred
at the instant of its extraction ; and the uncomfortable and op-
pressed state of breathing remaining after, all in their opinion
seemed to demonstrate the presence of the suspected body,
cither in whole or in part in some of the air-passages, and
Dr. Houston’s Case of a Tooth in the Trachea. 45
most probably in the right bronchial tube. The case, how-
ever, being of a very unique description, and the evidence in
proof of the presence of the foreign body in the windpipe not
being, in the minds of all, sufficiently decisive, it was deter-
mined, that for the present, no hazardous operation could, with
propriety, be undertaken. ‘The man was accordingly placed in
hospital, in order that farther observations on his condition
might be made.
Not having had from this period more than occasional in-
terviews with the patient, as he had passed from under my care,
and not being in full possession of the changes and treatment
he underwent, I must content myself with stating, that he
passed successively through the several stages of pneumonia,
bronchitis, and pleuritis, first of the right, and secondarily of
the left lung; that the early period of the illness having been
allowed to pass over, without the performance of any operation
for its relief, in consequence of the uncertainty and obscurity
hanging over the case, it was deemed prudent not to make any
unavailing attempt when the prospects of benefit from an ope-
ration had passed away ; and finally, that he died on the ele-
venth day from the occurrence of the accident.
The great interest excited by this case on account of the
novelty attached to it, and particularly on account of the differ-
ence of opinion respecting its nature, gave rise, of course, to a
desire among all persons acquainted with its occurrence, to
know the result of the post-mortem examination. Numbers
were assembled to witness the opening of the body, when, un-
expectedly, the friends refused their assent. No persuasion,
no entreaty, no bribery, could change their determination ; and
accordingly the corpse was removed from the hospital. How-
ever, having watched the procession, and traced the body to
the house in which it was laid, I at length, through the per-
suasion of the Rev. Mr. Brownrigg, and by his consenting to
remain present, obtained leave to make the wished for exa-
mination.
46 Dr. Houston’s Case of a Tooth in the Trachea.
The following is an account of the post-mortem, as noted
down at the moment of its performance.
Examination sixteen hours after death.—When the anterior
part of the chest was removed, and the pleura opened, the
lungs retained their natural fulness; no collapse on either side
took place. The right lung was adherent on every side to the
parietes of the chest, except posteriorly, where a considerable
quantity of thin bloody fluid lay between the pleure. The
pleural cavity on the left side was also obliterated by an univer-
sal adhesion. The lymph effused between the pulmonary and
costal pleuree of the right lung was in considerable quantity,
firm and opaque, and evidently of several days standing; that
especially, where the fluid noticed above was lodged, for
an extent of seven or eight inches, was very abundant and tena-
cious. The lymph which caused the adhesions on the left side
was in smaller quantity, and appeared only as a thin semi-
gelatinized stratum. In both, the pleura pulmonalis, when
stripped of the artificial membrane, exhibited a highly vascular
surface; on the base of the right lung it was red even to livi-
dity. All the adhesions were, however, easily broken through,
by pressure with the hand; they were obviously the product of
the recent attack of inflammation.
The substance of the right lung was hepatized in every
part ; its structure readily gave way under pressure with the
finger: and when cut into, the surfaces of the section dis-
charged a quantity of serum and dark fluid blood. The left
lung, though less advanced in disease, exhibited all the marks
of intense inflammation, its integral structure was dense, heavy,
and swollen with engorgement.
Such was the condition of the pleura and pulmonary tissue ;
the next and most interesting part of the dissection Jay in the
examination of the air-passages. On slitting open the tra-
chea from the larynx down to the lung, the obnoxious tooth
was discovered lying in the right bronchial tube, about one
inch beyond its commencement; the fangs were directed to-
Dr. Houston’s Case of a Tooth in the Trachea. 47
wards the lung, the broken crown looked up towards the
larynx. The bone lay loose in the tube, and came away rea-
dily when caught between the points of the scissors. It had
two long fangs, and when tested with the splinter, which had
been broken off in the first attempt at its extraction, and pre-
sented to me by the man while alive, was found to fit most ac-
curately to it, and make a perfect tooth.
1. The portion of tooth found in the lung, with the fragment at a short distance.
2, The tooth and fragment, of the natural size, joined together.
The mucous membrane of the air-passages, from the larynx
to the finest ramifications all through both lungs, was in a state
of intense inflammation ; it was tumid and softened in consist-
ence, and of a deep red colour, as if injected, ‘The tubes were
occupied by a muco-purulent fluid ; but there was no abscess
around the tooth, nor even did the structures in the immediate
vicinity of the foreign body exhibit a much higher degree of
inflammation than those which were more remote.
None of the organs in the chest presented any marks of the
existence of previous disease. The pleuritic adhesions were not
of longer standing than the period occupied in the course of
the late fatal attack; and there were neither tubercles, nor
tubercular cavities in any part of either lung.
This case deserves to be recorded for several reasons :—
First, on account of its rarity. Secondly, as it shows that a
body, apparently much larger than the aperture of the rima
glottidis, and one even of different form, can find a passage
48 Dr. Houston’s Case of a Tooth in the Trachea.
through that fissure. Thirdly, because it proves that so ob-
noxious a foreign body as a full grown molar tooth may lie for
a time in the windpipe, without being productive of much
inconvenience. ourthly, on account of the additional evi-
dence which it supplies of the justness of Mr. Key’s statement,
that the right bronchus is the usual resting place for foreign
bodies, which have passed the larynx. J%fthly, on account of
the practical observations made soon after the accident on the
state of the respiration, by percussion and the use of the stetho-
scope. And sixthly, because by the sectio cadaveris, the cha-
racter of inflammatory action induced by the presence of a
foreign body in the bronchial tubes is demonstrated.
Respecting the first of these positions, viz. the singularity
of the case, nothing such to my knowledge is on record. It is
probable that such an accident was never dreaded by any one
setting about the extraction of a tooth: and as the like may
never occur again, the registry of it may rather be placed among
the “ cas rares,” than held out as a caution against the prac-
tice of tooth drawing.
Secondly : to understand aright how a body of greater ap:
parent dimensions than the rima glottidis could have found a
passage through that aperture, it is only necessary to reflect for
a moment on the nature of the process of inspiration. ‘The in-
troduction of air to the lungs with every breath, is consequent
upon the enlargement of the chest—the weight of the atmosphere
pressing the adjacent column into the cavity with a rapidity
proportioned to the suddenness and extent of the dilatation,
and with a force sufficrent to carry along in the current any
light moveable body, which may happen to come in the way.
A small body so intercepted, will readily pass with the air
through the rima, and be lodged in a part of the tube lower
down. A body of inordinate dimensions may stick so firmly
in the aperture, that the full weight of the atmosphere is un-
equal to its propulsion onwards, and death from suffocation
will be the inevitable consequence, if the foreign body be not
Dr. Houston’s Case of a Tooth in the Trachea. AG
instantly shot back again by a powerful expiratory effort, or
removed by operation. And, a body of intermediate size, viz.
one of such moderate dimensions, as to be capable of passing
through the rima, by stretching and divaricating the sides.
of that aperture, may, when pressed heavily by the atmosphere,
as it would during a forced inspiration, be driven past the ob-
struction, and thence into the trachea or bronchial tubes.
Such latter was, no doubt, the mode by which the tooth. .
in the case above related, found a passage into the bronchus.
The man, holding his breath during all the time of the opera-
tion, suddenly at the moment in which the extraction was com-’
pleted, took a full inspiration; upon which, the tooth, partly
by its gravity, (the head being at the time thrown back,) and
partly carried by the air rushing to the windpipe, fell over the
aperture leading into that tube. The obstruction caused thereby
to the further entrance of air, induced a spasmodic increase of
action in the muscles of imspiration, and a consequent increase
of pressure by the air at the opening, by which the tooth was
driven with force through the fissure.
Thirdly: as to the freedom from pain or irritation from the
presence of the foreign body, during the early part of the pa-
tient’s illness, it constitutes an important fact to be borne in —
mind in making a diagnosis in such cases: the absence of this
sign had certainly much influence on the diagnosis of the case
in question. It has been long ago observed by Louis, and the
accuracy of the observation has been since confirmed by others,
that foreign bodies in the air passages produce more irritation
when lying in the neighbourhood of the larynx, than when low
down in the trachea ; and that according as they are carried up
er down by the air in breathing, so will the patients be afflicted
with cough and dyspneea, or have freedom from such sufferings.
The accuracy of the observation receives additional proof from
the history of this case. The tooth, a large heavy body, not
admitting of elevation by the expired air, lay uninterruptedly m
VOL, v. NO. 13. H
50 Dr. Houston’s Case of a Tooth in the Trachea.
the bottom of the trachea, and, as Louis significantly observes,
“‘ lay easy.”
Fourthly: the case here related tends to confirm the opi-
nion now generally entertained, that the right bronchus, in pre-
ference to the left, is that usually occupied by a foreign body
carried by the air through the trachea. It was into this part
that Mr. Key found a sixpence to drop, when let fall in the
dead body through the rima glottidis ; and it was here that he
discovered the sixpence which caused the death of the indivi-
dual whose case led to the performance of such experiments.
The multiplication of proofs in favour of an important patholo-
gical fact, and one which may lead to greater accuracy of diag-
nosis, and greater precision in the performance of any opera-
tion, undertaken for the safety of human life, is of great value ;
and it is obvious, that such must be the tendency not only of
Mr. Key’s highly interesting communications, but of that just
offered by me in corroboration of his statements. With re-
spect to the possibility of saving, by an operation, the life of
the individual in question, no more can at present be said,
than that some attempt would most likely have been made,
had the presence of the tooth in the right bronchus been clearly
ascertained ; and that the forceps recommended by Mr. Key,
consisting of two long narrow blades, capable of being passed
down the trachea through an artificial opening, might have
been those to which a trial would have been given. It is clear,
that the ordinary operation of making an opening in the wind-
pipe, through which the offending body might be expelled by
the efforts of expiration would not have been sufficient. ‘The
tooth should have been actually lifted from the right bronchial
tube by mechanical means; otherwise its removal could not
have been accomplished. The weight of the body would have
opposed its elevation from the bronchus by any force which the
expired air could exert upon it; and its size and irregularity
of form would have been unfavourable to its discharge through
such an opening as the calibre and connexions of the trachea
would admit of.
Dr. Housten’s Case of a Tooth in the Trachea. 5k
Fifthly: the application of the stethoscope to the detection
of foreign bodies in the air passages, is a recent improvement in
the use of that valuable instrument. ‘The absence of respiratory
murmur in one lung during inspiration, when, by percussion, it
is proved that the cells of the organ are healthy, and filled with
air, is, in a case of this nature, a clear proof of the presence of
an obstructing body in the bronchial tube leading to the af-
fected organ ; and the circumscribed mucous rale, audible in the
same place, may be considered as indicative of an increase of se-
cretion, caused by the presence of the local irritation. These
phenomena, so intelligible consequences of the accident, and so
characteristic of its nature, were first observed in this city, in
two patients in the Meath Hospital, and their presence alone
justified and led to the performance of successful operations for
tracheotomy.* |
Sixthly: the pathological condition of the thoracic organs of
this patient presented some points of interest. The morbid
changes induced by the late inflammation, were not all of equal
standing; they had, on the contrary, commenced in different
parts in succession, and might be traced as from a centre, re-
ferrible to the right bronchus the seat of the tooth—through
the mucous membrane, pulmonary tissue and pleura, first of
the right, and subsequently of the left lung, until all these
textures were involved in the same disease. Ordinary instances
of bronchitis induced by cold, are not prone to run rapidly into
pneumonia, and much less to spread to the serous membrane
covering the lung ; the case, however, appears to be very different
where the inflammation of the mucous membrane is caused by
the presence of a foreign body, as is shewn by the dissection
of the lungs in the individual, the subject of this communi-
cation.
* These two highly interesting cases are recorded in the 5th vol. of the Dublin
Hospital Reports, by Professor M‘Namara. |
32 Dr. Montgomery on the occasional Occurrence of
Art. [X.—On the occasional Occurrence of Mental Incohe-
rence during Natural Labour. By W. F. Monrcomery,
M.D., Professor of Midwifery to the King and Queen’s
College of Physicians in Treland.
Pernaps I cannot more appropriately introduce the remarks
which I have to offer on this subject, than by quoting, as a pre-
liminary observation, one prefixed to a highly instructive and
valuable paper on vaccination, lately published by Dr. Maun-
sell in this Journal, his words are: “a very limited experience
must be sufficient to expose to any thinking person the fallacy
included in the supposition, that the difficulties and perplexities
of a practitioner are chiefly to be met with in the more danger-
ous and rare cases of disease.” Now, if there be one subject
more than another, to which such a fallacy is found to extend
its influence injuriously, it is that of natural labour, the laws,
circumstances, and phenomena of which are usually considered
as matters of such constant and common-place uniformity, that
it is deemed quite enough to have ascertained, that a labour is
natural, to enable us to anticipate every symptom that will arise,
and understand every circumstance likely to occur during the
whole of the process; in short, that as soon as we have been pre-
sent at a few cases, we may with a safe conscience rest satis-
fied, that we know all that is to be known of the matter, and
adopt the comfortable maxim, “ ex uno disce omnes,” a rule
of discrimination which we might, with just as much propriety,
attempt to apply to the human head and face, and assert their
universal similarity, because there is in all an assemblage of
the same parts ; but even in those which are to the careless ob-
server indistinguishably alike, how easily does the quick and
practised eye of the anatomist detect imperfection of structure
or irregularity of arrangement, or the phrenologist or physiog-
nomist recognize the characteristic differences which distin-
guish the philosopher from the sensual voluptuary or the vil-
Menta! Incoherence during Natural Labour. 53
lam; so also will the skilful painter discover and appreciate
varieties in proportion or expression, which as perfectly dist'n-
cuish one individual from another, as if they belonged to diffe-
rent species; and by such nice discrimination of these more
delicate points, and his power of treating them correctly, does
he earn for himself well-merited praise and high reputation ;
and so it is or ought to be in our profession; and my belief is,
that there are not to be met with any two cases of labour,
which, if carefully observed, will be found precisely alike ;*
nor any one case which, when attentively watched, will not pre-
sent to us some interesting variety of circumstance, or suggest
some new idea, thereby adding to that stock of knowledge,
which is to render us afterwards more certainly useful to our
patients, and consequently assist us in advancing to professional
eminence, by means which are at once the most creditable,
safe, and certain. It is by no means my intention to trespass
on the time of the reader or weary him, by even an enumera-
tion of the symptoms or aggregation of circumstances, which
usually present themselves in natural labour, with which, I will
take for granted, that he is already perfectly familiar; but I
may be permitted to advert to one fact vitally connected with
our subject, for the purpose of shewing how slowly some, even
of the circumstances apparently easily known, became objects
even of consideration, much, less of knowledge. I allude to
the relations which the head observes with regard to the pelvis,
as it descends through that cavity and issues from its outlet :
now, strange as it may appear, it is nevertheless not more strange
than true, that although men of great talent and observation
were employed in the practice of midwifery, and distinct trea-
tises were written on the subject, so far back as the beginning
%* Such also, and even more decided, was the conclusion to which Denman’s
experience and talents led him ; ‘¢ we may,” says he, “ probably never meet with
any two labours in any respect exactly similar.” p. 284. ed. 5.
54 Dr. Montgomery on the occasional Occurrence of
of the seventeenth century,* when the works of Ambrose Paré
were collected and translated, when the great Harvey prac-
tised midwifery, and wrote his “ Ewercitationes de partu,”
and when Ruysch was elected Professor of Midwifery by the
States of Holland, still no idea was entertained of the true me-
chanism of the passage of the head, nor was even an attempt
made to explain it, until the middle of the eighteenth century,
when Sir Fielding Ould, then master of the Dublin Lying-in-
Hospital, published his view of it in 1742;+ in fact, we had
no full, clear, and satisfactory account of it, until Negelé of
Heidelburgh published his “ Mechanism of Parturition” in
1829.t And yet I need not here insist, that on the correct and
intimate acquaintance which we possess of these relations, and
our expertness in detecting them by examination, depends al-
together our capability of managing or correcting malpositions,
and of applying and using instruments with advantage and
safety. Still I regret to believe, that there are many, very many
who consider it quite sufficient to have ascertained the present-
ing part to be the head, to satisfy them that all is right, and
who, to use the words of Dewees, “ committhe whole charge of
the labour to the management of nature, if the head present,
no matter how, and as she is usually successful, however hard
the struggle, never stop to inquire whether they could have
aided her efforts or abridged her toils ;Ӥ never considering
* I am aware, that there were publications of even earlier date, as for in-
stance, ‘‘ The Byrthe of Mankynde, or the Woman’s Booke,”’ in 1540, but they are
not of any authority.
+ Before that period it appears to have been taken for granted, that because
the head issued from the pelvis with the occiput towards the pubis, and the face
to the sacrum, it passed into and through the pelvic cavity in the same position,
which was accordingly designated as the “ situs capitis rectus et equus.”’ See
figure in Mauriceau, vol. i. edit. 1712, p. 243, and also Deventer’s 8th and 9th
plates, French edit. 1734, pp. 95-6.
¢ Negelé’s book was printed in Germany in 1822, but it was not known in
this country until the publication of Dr. Rigby’s translation in 1829.
§ Compendium of Midwifery, page 237, par. 577.
Mental Incoherence during Natural Labour. 55
that there are at least five varieties of relation between the head
and the pelvis, each of which is accompanied with a corres-
ponding difference in the circumstances of delivery, and, of
course, may require a very different mode of management.
If in dwelling even thus long on matters so familiar to most
of my readers, I have trespassed on their patience, I can only
urge in extenuation, the extreme importance of the subject of
natural labour, which Denman tells us, “‘ was the last thmg well
understood in the practice of midwifery ;” * and the engrossing
interest with which it is invested, as being not alone a delicate
branch of professional inquiry, but also a process whose results so
powerfully influence our domestic happiness, and are associated
with some of the purest and tenderest feelings, which spring
from and cement the most sacred of our social relations.
I shall now proceed to notice the particular symptom of in-
coherence during natural labour, to which I wish to call atten-
tion ; and I am the more anxious to do so, because, as far as I
am aware, it has not been described by any writer on mid-
wifery. It is well known, I presume, to every one who is con-
versant with the management of labour, that the period of that
process at which the os uteri becomes fully dilated, and is put
severely on the stretch by the head passing through it, is one
of extreme distress and pain to the patient, who generally at
that time is much agitated, experiences a smart rigor, and
vomits ; but in addition to these and other symptoms of almost
constant occurrence, I have observed, that the impression thus
made on the system is in so many instances accompanied by
incoherence or temporary delirium, that I have ceased to re-
gard its occurrence as a matter of surprise ; and yet I confess,
that I was six years engaged in the practice of midwifery, hav-
ing also attended the Lying-in-Hospital for two years and a
half, before I took notice of this fact, which was at length
* Introduction to Midwifery, ed. 5, p. 268.
56 Dr. Montgomery on the occasional Occurrence of
presented to my observation in characters so forcible, as not to
be overlooked or easily forgotten: since then, I have watched
closely, and have frequently met with it; sometimes strongly
marked, at others so slight as almost to escape observation ;
but perhaps the best description I can give of this circum-
stance, will be collected from a brief detail of some of the
cases in which it was observed. I shall therefore select three
out of those in which it occurred under my own observation,
and three others which were communicated to me in conse-
quence of my having discussed the subject in my lectures.
Case J.—A. 8. in labour of her second child, of very irri-
table temper, was going on favourably, and without any symp-
tom calculated to excite attention, until the rupture of the
membranes, which took place before the os uteri was fully di-
lated, the pains increased. in strength, and the head began to
press hard into and stretch the os uteri: in a few minutes after-
wards, on my asking her some indifferent question, she popped
her bare leg out of the bed, and requested that IT would unlace
her boot and take it off, for that it made her very uncomfortable,
and was insupportably hot in such warm summer weather ; then
a pain or two passed over, and she again reiterated the request
about my taking off her boots, or that I would allow the nurse
to do so, and if not, that I would at least pour the contents of
the water jug over her to cool her; then two or three pains
more passed over, and she started on a new theme, “ Doctor,
don’t you think Mr.
him a charming man, I wish I was married to him, and
S
name she mentioned, was, perhaps, the ugliest man to be found
any where : all this lasted about a quarter of an hour ; the head
then passed the os uteri, and she presently dozed a little; the
is a very handsome man, I think
might marry any one he liked.” The gentleman whose
labour afterwards went on for several hours, and rather severely,
but she had not the slightest return of the incoherence, and re-
covered well. ‘This was the first time I had observed this oc-
currence, and it alarmed me exceedingly.
Mental Incoherence during Natural Labour. 57
Cass IL.—Mrs. D. aged 25, of very irritable habit, and ra-
ther ardent temper, sent for me at ten o'clock, rp. M. ; it was her
first labour, and was proceeding actively with powerful pains.
At half past one the membranes ruptured, and the head began to
bear upon and into the os uteri ; at two o’clock, when this part
was fully on the stretch, and she was covered with perspiration,
she turned to me and said, that she “ would not go down to the
drawing-room ; for what would visitors think if they saw her sit-_
ting there, and she in labour? and that I need say no more on the
subject, for that she would not do it, but that she would have
no objection to step into the coach and start off for Ballybay ;”
here she concluded, began to doze a little, and wandered no
more; the head soon after came down upon the perineum, and
a little after three o’clock she was safely delivered of a very
large and healthy boy, and recovered well. I since attended
this lady, and she had no return of this symptom.
Case III.—Mrs. S. aged about 40, remarkably healthy and
even tempered ; in her ninth labour, which began on the 14th
by the dribbling away of the waters, she had a few slight pains
in the course of that day, but the labour did not increase or
become active till nine o’clock, p. m. of the 15th, when the
pains were quick and forcing, and about twelve o’clock mid-
night, she turned to me and said, that she “ thought it would
be time for her to get up and see the children dressed and
sent to school, otherwise they would be late ;” then she ex-
pressed great surprise as to what could be preventing her mo-
ther from coming to town, to be with her during her confine-
ment, which, she said, she knew would take place before her
arrival ; her mother was at the moment standing by her bed-
side and holding her hand: presently the head descended fully
into the cavity of the pelvis, and the incoherence ceased after
having lasted about five minutes. She was safely delivered at
twenty minutes before two o’clock, a.m. of the 16th.
Case TV.—An extremely intelligent gentleman, son of a
physician in England, who was attending my lectures in
vol, v.. No. [a I
58 Dr. Montgomery on the occasional Occurrence of
1831, told me, that my account of this matter was very satis-
factory to him, as explaining a circumstance which had hap-
pened in his father’s practice, which had been at the time
of its occurrence a source of extreme alarm, and had always
appeared to them both totally unaccountable. He had been
attending a lady of rank in labour, she was remarkable for
the gentleness of her disposition and propriety of conduct ;
every thing appeared to him to be going on perfectly well, and
the labour promised to be speedily terminated, when the lady, in
reply to some question from the doctor, desired him to go be
damned for a scoundrel; and then followed up this singular
address by language not less remarkable for its indecency,
than for the inappropriate circumstances under which it was in-
troduced ; this, however, lasted only a few minutes, when she
became quite calm, and observed, that she believed she had
been talking nonsense, but did not know of what kind: her labour
was happily terminated in a very few hours, and she recovered
well; but from that time, Dr. and his son always considered
her as a person liable to insanity, until the latter heard me
describe such occurrences as not unusual.
Casz V.—The account of this case was very kindly com-
municated to me by Dr. Young, of Ormond-quay, in conse-
quence of hearing me lecture on the subject. I shall give it
in his own words :—
‘“ Upper Ormond-quay,
“My Dear Sir,
“ Agreeably to your request, I furnish you with
an outline of a case which fell under my observation, and which
you seemed to think deserving of attention, as far as,regards a
peculiar symptom, which has not, I believe, been noticed by
practical writers. The symptom I allude to is, the slight but
marked delirium, which sometimes attends natural labours, just
as the head of the foetus is passing through the os uteri, which
is then forcibly distended and exccedingly on the stretch.
Mental Incoherence during Natural Labour. 59
“On the 14th of March I was called upon to see Mrs. R. H.
of Mabbott-street, aged 20, then about to be confined with
her first child. The labour was perfectly natural, and con-
tinued active for at least eight hours; I thought it necessary to
leave her room for a few minutes, and on my return, I found
that the membranes had been ruptured, which I attributed to
the interference of the nurse. The pains now became more
violent, the head forcibly pressing through the os uteri, when
at this moment I was greatly alarmed by her incoherent ex-
pressions, (as if in conversation with her relations, who were at
that time in the country,) and was induced to suppose, that
these were the premonitory symptoms of an attack of convul-
sions; but I was agreeably relieved in about two minutes from
my great anxiety, by the complete subsidence of these (as |
then thought) alarming symptoms; in fact, the child was en-
tirely expelled after a few pains, and the lady’s recovery was
uninterrupted.
« Faithfully your’s,
“ Ken*. Youne.”
Case VI.—For this case I am indebted to Dr. Paterson,
of Blessington-street, whose account of it I shall transcribe, to-
gether with his very judicious preliminary observations :—
‘¢ 32, Blessington-street.
“ Dear Sir,
“ As the reputation of the physician is as
much endangered by being alarmed without cause, as from not
observing danger when it really exists; and as in the practice
of medicine, a knowledge of the causes of disease in general,
renders our prognosis clear, our treatment decided and efficient ;
so in that of midwifery, every fact founded on observation,
which elucidates the causes of symptoms, and which tends to
prevent unnecessary alarm in the mind and conduct of the me-
dical attendant, ought faithfully to be recorded. In accordance
with this sentiment I send you the annexed case, in whose first
60 Dr. Montgomery on the occasional Occurrence of
stage symptoms occurred, which, during their contmuance, oc-
casioned me considerable anxiety.
“In the month of October, 1831, Mrs. S., a lady aged 30
years, of a strong but nervous constitution, pregnant of her first
child, and at the full period of utero-gestation, was at two
o’clock, a. M., awoke with the precursory symptoms of labour.
There was neither headach nor fever, and little, if any excite-
ment of the pulse, but she was now, as she had been during
the greater part of gestation, unusually anxious and despond-
ing as to the result. Her diet, exercise, and bowels, had been
carefully regulated, and every proper means to remove her ap-
prehension adopted. The os uteri was contracted and sleghtly
rigid; an emollient enema was administered, and rest—sleep if
possible, advised.
“‘ Five o’clock, a. m. She had not slept, but expressed her-
self soothed by the enema which produced the desired effect ;
the pains were sharp and frequent ; the voice characteristic, and
the os uteri now dilated to nearly the size ofa shilling ; she com-
plains much of cutting pain in her back; no headach; pulse
quiet; little thirst. Her bed-chamber was large, well venti-
lated, and cool ; no fire nor any stimulant allowed.
«¢ Seven o’clock, a.m. Os uteri dilating gradually though
slowly ; when my patient began to talk incoherently, and ulti-
mately to sing a favourite Italian air, which, I understood,
she had been playing the day previous. She had spoken
collectedly the minute preceding; from this error mentis she
was at once recalled, by applying cold to her forehead and
speaking mildly to her, when she expressed herself aware of
> in the interval she
having “ done or said something foolish,
complained of the lancinating pains, and again resumed the
wild melody ; from which I always with ease recalled her. Al-
ternate moments of sensibility and delirium occurred, till half
past eleven o’clock, a.m., when the os uteri being almost fully
dilated, the membranes and head. presenting, the tendency to
wander ceased, and though the external parts did not dilate
Mental Incoherence during Natural Labour. 61
kindly, the delirium did not again recur ; her recovery was fa-
vourable.
“ T candidly acknowledge I was at first alarmed ; but the
quiet state of the circulation; the freedom from fever or local
determination ; the ease with which I recalled her to perfect re-
collection and sensibility; by leading me to consider the inco-
herence as the effect of pain in a highly hysterical individual,
(as my patient undoubtedly was,) allayed my fears, and enabled
me to think with coolness and to act with deliberation. I have
not mentioned what perhaps I should, that I could not then ac-
count why the delirium, if arising from the pains, did not con-
tinue as long as they did, nor did I distinguish between the ef-
fects of the pain of dilatation of the os uteri and of expulsory
action, till my conversation with you on the subject gave me
reason to attribute the mental affection to the former.*
“« Very truly yout’s,
‘¢ Henry Paterson.”
Such are the characters and accompanying circumstances of
this species of incoherence, which it appears to me of great
importance to have known, and properly appreciated, espe-
cially by those who have had but little experience in prac-
tice, but who may have learned, that delirium in labour is
to be regarded as a dreadfully dangerous occurrence, which
it undoubtedly is, when it comes in the train of other bad
symptoms, accompanying a difficult and protracted case ; but
this form of incoherence of which I speak, has no affinity
with such7a*condition; it comes on suddenly, during per-
fectly natural and favourable labour, and most frequently at
the particular stage of the process which I have pointed out ; it
is not accompanied or followed by any other unpleasant or sus- |
picious symptom ; it occurs, perhaps, immediately after the
ROTEL A. OGG R ie Joie TARO 1O Syren 2 be
* This lady was since confined a second time under Dr. Paterson’s care, with-
out any return of incoherence,
62 Dr. Montgomery on the occasional Occurrence of
patient has been talking cheerfully, and having lasted a few
minutes, disappears, leaving her perfectly clear and collected,
and returns no more, even though the subsequent part of the
labour should be slower and more painful. In every instance
which came under my observation, the patients were afterwards
conscious that they had been wandering, and occasionally apo-
logized for any thing wrong they might have said, although
they were not aware of what the exact nature of their obser-
vations might have been, their condition, so far, exhibiting
that mental embarrassment observed by Dr. Gooch,* as occasion-
ally occurring “ in women who had been debilitated by nursing,”
in which “ the mind was wrong, yet right enough to recognize
9
that it was wrong.” Now should the practitioner in attendance
not happen to be aware of this fact, his fears would almost cer-
tainly be alarmingly excited, and might, perliaps, induce him
to pronounce an opinion, or adopt a course of treatment, under
the apprehension of imminent danger, which the subsequent
circumstances of the case would not justify, and which might
even be highly injurious. Thus, one gentleman states, that he
was sure his patient was about to be seized with convulsions,
and had the symptoms continued, he would probably have
felt himself called on to bleed her, or request further advice,
neither of which is desirable when unnecessary: another told
me that he fully anticipated the approach of puerperal mania,
anda third, that although from the time of the occurrence, he
never recognized any further symptom of derangement, he had
always considered the lady as of unsound mind, until I men-
tioned to him what I had observed ; and precisely the same dis-
tressing impression was made on the husband and family of
another lady, until I relieved them by describing the circum-
stance as one which I had several times met with, and to which
I attached no consequence; an assurance which was received
_with almost a transport of delight and satisfaction. I have al-
* Account of the Diseases of Women, p. 114.
Mental Sevens during Natural Labour. 63
ready said that this occurrence is not described by authors, and
I did not venture to make that assertion until I had carefully
examined the works of Denman, Burns, Merriman, Gooch,
Hamilton, Smellie, Dewees, Gardien, Velpeau, Desormeaux,
Baudelocque, Boivin, Mauriceau, La Motte, Deventer, and
Stein, of whom, only two* mention such an occurrence at all,
and they merely state generally, with regard to labour, that
sometimes, when it is violent and under peculiar circumstances,
(which they do not describe or specify), the woman “ becomes
delirious, or suffers a transient disturbance of the intellectual
functions ;” but they have given no account of the form such
incoherence assumes, its distinguishing characters, or the accom-
panying circumstances ; nor have they or any body else, as far
as I know, reported any case calculated to call attention to the
subject ; and although I find, upon inquiry, that it has occurred
to other professional men, (as in the cases already related,)
they stated to me at once, that they recollected it only as having
greatly surprised and alarmed them, and that until they heard
my account of it they had never thought of connecting it with
any particular cause, or part of the process, or in fact had re-
garded it as anything more than one of those strange and un-
accountable incidents which occasionally spring up to astonish
and embarrass us in practice.
I should also observe, that I have known the same circum-
stance happen in abortion, when the ovum was forcing through
the rigid cervix and os uteri; but more frequently the effect
then produced is extreme faintness, and a degree of exhaustion
totally disproportioned to any appreciable cause, such as ha-
morrhage. TI lately attended a lady, who was miscarr ying in
the second month, with slight hemorrhage, and during the
distention of the lower part of the cervix uteri, such a degree
of faintness and exhaustion prevailed, that she was almost
ng rt rn EL
* Gardien, Traité d’Accouchmens, tom. ii. p. 224, and Desormeaux, Dict. de
Med. tom, i. p. 170.
64 Dr. Montgomery on the occasional Occurrence of
completely insensible for more than an hour; but no sooner
was the ovum expelled into the vagina and removed, than she
revived again and felt quite well, a very satisfactory proof
that the symptoms of exhaustion had been the result of the pe-
culiar impression made at the time on the brain and nervous
system. The subjoined fact also appears to me of considerable
interest, as illustrative of our subject. A professional friend in-
formed me, that an attempt made by him to dilate the os
uteri for the cure of dysmenorrhcea, as recommended by Dr.
Mackintosh, was accompanied by excessive distress, and such
complete incoherence on the part of the patient, that he was
afraid ever to renew the operation.
It should not be forgotten, that there are many other cir-
cumstances connected with pregnancy and parturition, which
are so much in unison with the occurrence of the symptom
now spoken of, as to render its appearance a matter of less
surprise or singularity. It is well known that in almost all
women, but especially in those of an irritable habit, con-
ception is followed by very obvious alterations in their moral
temperament, apparently depending on a state of exalted ner-
vous sensibility, or, as Dtenman* well expresses it, “ m conse-
quence also of this general and perpetual irritation, the temper
of pregnant women is sometimes rendered less gentle and pa-
tient, than is consistent with their usual character, and this
claims compassion instead of resentment ;” in some the irrita-
bility assumes the extraordinary and protean forms of hysteria,
and occasionally the patient’s condition is such, that it would be
no easy matter to draw the line of separation between it and
absolute mental aberration, or, at least, what is usually called
an unsettled state of mind; while in others complete de-
rangement takes place. A patient of my father-in-law’s, the late
Dr. Connor, became deranged in eight successive pregnancies,
and very lately a woman was received into the Richmond Lu-
* Introduction to Midwifery, p. 216.
Mental Incoherence during Natural Labour. 65
natic Asylum, who was three times similarly affected during _
gestation, but always became sane a short time before delivery,
and continued so until the re-oceurrence of pregnancy. It is
also a fact universally acknowledged, that the nervous system
of all parturient women, is in a state of peculiar excitement
and impressibility, by which they are rendered most painfully
sensitive to the slightest moral or physical disturbances, and
the very circumstance of the dilatation of the os uteri in labour,
is In some a source of irritation sufficient to induce that fearful
affection of the brain, which we believe to constitute in many
cases the essential cause of puerperal convulsions; and the
appearance of mania during the state of child-bed, is of too
frequent occurrence to require more than to be mentioned.
Nor shall we be ata loss for some very close and striking ana-
logies if we leave this particular system altogether, and turn
our attention to other organs and their functions : thus it must
be familiar to many, how frequently children become incohe-
rent, especially at night, after having paid a visit to the pastry
cook’s shop, and received into their stomachs a quantity of in-
digestible matters; an effect which I once saw remarkably
_ exemplified in an adult: the gentleman was then a medical
student, went to the theatre, and after his return supped on
lobster and mutton kidneys, after which he drank two or three
glasses of wine and nothing more; the following morning he
got up as usual, and went to a gentleman who was preparing
him along with others for his examination ; he was, in general,
as I was informed, remarkable for the extent of his information
and good answering, but on this occasion his replies were the
most unqualified nonsense: in consequence of which, he was
advised to return home and rest himself ; which he did; but
shortly after his arrival at his lodging, I was sent for in
great haste, in consequence of his having fainted. On his re-
covery I asked him if he felt sick ? he said not: I asked if his
bowels were out of order ? he said not; that they were confined,
but that if he had diarrheea it would cause an effusion of coagu-
VOL. v. No. 13. K
66 Dr. Montgomery on the occasional Occurrence of
lable lymph, which would put an end to the insenstble perspira-
tion: he was very cold and shivering. I got him ito bed, gave
him a little warm wine and water, and applied heat to his feet.
While these measures were in progress, I ascertained what f
have already stated, about the supper he had eaten, which
it seemed also was a very unusual thing with him to do, as he
was of remarkably temperate and regular habits; his tongue
was foul, and his abdomen felt full and doughy, as if the bowels
were much loaded. J ordered an active purgative, to be fol-
lowed by an injection. Ina few hours afterwards, I had the
advantage of Mr. Colles’ advice, to whom he was serving his
time ; he advised the aperients to be repeated, as the for-
mer dose, &c. had acted only slightly: he was quite aware
that he had been talking nonsense to us in the morning, for
which he apologized ; but he was, nevertheless, still quite inco-
herent; anda moment afterwards, in answer to a question from
Mr. Colles, as to what wine he had drank the night before, he
said he had taken “ only three glasses of intertrochanteric wine,
which you know, Sir, is the proper name for port.” In the
course of the evening the bowels were: relieved plentifully,
and the previous night’s supper discharged almost exactly in
the state it had been swallowed; he got several hours good
sleep during the night, and in the morming was as perfectly
collected as ever, nor had he ever to my knowledge any return
of the annoyance. Since then he passed his. examination with
distinguished credit before the College of Surgeons.
Dr. Gooch relates a still more remarkable case, in which
mania after delivery was induced by disorder of the alimentary
canal, and subsided immediately upon the expulsion of the
offensive matter from the bowels.*
In conclusion I may observe, that an explanation of this
phenomenon seems to me to arise naturally from_a considera-
aa nnn en a
* On the Diseases of Women, p. 156.
Mental Incoherence during Natural Labour. 67
tion of the anatomical structure of the part principally engaged,
the changes which it undergoesat the time, and the physiological
condition of the uterus resulting from pregnancy. With regard
to the former, we know that the lower part of the cervix, or that
surrounding the os uteri, has the structure, and performs the func-
tions of a sphincter, and that forcible or extreme dilatation of
such parts is always productive of great distress ; and in the
present instance, we have an aperture, which, this hour, would
hardly admit the point of our finger, before the end of another
hour, dilated to such a degree, as to give passage to a body,
measuring at least from ten to twelve inches in circumference ;*
in doing which, it is sometimes so stretched, as to tear in seve-
ral parts, and thus gives rise to the jagged or notched state of
the part, so constantly found in women who have borne several
children. I think also, I have sufficient evidence to believe that
this incoherence will most frequently be observed in cases where
the membranes have given way, or have been imprudently rup-
tured, too early in labour, by which the expulsive action of the
uterus suddenly acquires increased force, and impels prema-
turely, the hard, bulky, and unaccommodating head against the
os uteri which it carries down before it, untila portion of the
lower part of the cervix is caught and severely pressed between
the head, and the bony wall of the pelvis, which greatly adds to the
pain and distress experienced, and besides throws the part into a
condition still more unfavourable for dilatation. This theory (if
it deserve such a name) is fortunately one, which, whether true
or false, may be entertained with safety, inasmuch as the conduct
to which its reception would lead, could have no other than
a good effect, since it merely furnishes an additional precaution
* It may be proper to observe here, that this is not the greatest circumference
of the child’s head, which is that measured from the occiput, over the parietal pro-
tuberances, and round the forehead, which amounts to from thirteen to sixteen inch-
es ; but that is not the one presented to the os uteri in natural labour, in which the
head passes in such a position, that its outline is nearly a circle, whose diametet is
the bi-parietal or transverse dimension of the cranium, or nearly so.
68 Dr. Montgomery on Mental Incoherence during Labour.
against a premature interference with the membranes. Lastly,
we know that the part of the cervix around the os uteri re-
ceives a very abundant supply of nerves from the great hypo-
gastric plexus, and thereby establishes intimate connexions with
the branches of the renal and spermatic plexuses ; which nervous
supply becomes not only physically increased during the time
of gestation,* but (in common with the other constituents of
the organ) has its functional activity or its peculiar sensibility
greatly exalted, manifesting its irritative influence, not only by
the derangement caused in the action of certain viscera, as the
bladder, stomach, and intestines, but in anmy instances disturb-
ing seriously the whole system, and inducing effects already
adverted to.
Such an explanation appears to me not only reasonable in
itself, but the more satisfactory from its corresponding so closely
with that offered by Dr. Gooch, to account generally for the dis-
orders of the mind in lying-in women, which is the following:
“ the sexual system in women is a set of organs, which are in ac-
tion only during half the natural life of the individual, and
even during this half, they are in action only at intervals,
During these intervals of action, they diffuse an unusual
excitement throughout the nervous system; witness the hys-
teric afiections of puberty, the nervous susceptibility which
occurs during every menstrual period, the nervous affections
of breeding, and the nervous susceptibility of lying-in women.
I do not mean,” he adds, “ that these appearances are to be
observed in every instance of puberty, menstruation, pregnan-
cy, and child-bed, but that they occur sufficiently often, to
show that these states are liable to produce these conditions of
the nervous system ;”+ but he makes no mention, either in his
essay on that subject or elsewhere, of the occurrence which we
have been here considering, and which appears to me a forcible
illustration of the general law just referred to, while, in the
* Vide Tiedeman’s Tabula, et Nervorum Uteri Descriptio. t Op. jam cit.
Dr. Little on the Treatment of Diseases of the Lungs. 69
particular instance before us, we can moreover ascertain the
connexion or at least the coincidence between the mental affec-
tion and the existence of a powerful impression made, at the
time, on a peculiarly sensitive and irritable part of a system,
which we know does, even under ordinary circumstances, exert
so decided an influence over not alone the physical, but also the
moral and mental constitution of the female.
P.S. Should any facts, illustrative of the subject of the fore-
going observations, have presented themselves to the reader, I
beg to say, that I would consider their communication as a favour.
18, MoLEsworTH-STREET.
Art. X.—Practical Observations on the Treatment of some of
the Diseases of the Lungs, §c. By Roxserr Lirriz, M.D.,
Lecturer on the Institutes and Practice of Medicine in the
Belfast College. Physician to the Belfast Hospital. Phy-
sician Accoucheur to the Belfast Lying-in Charity, &c. &c.
Ir is more particularly in extensive hospital practice that the
physician has it in his power to form a just estimate of the
comparative merits of different remedies for the mitigation or
cure of disease. The want of an opportunity of observing a
sufficient number of cases, has led practitioners of much merit
into great errors, respecting the advantages of various remedies,
for it is, in fact, only by the most careful comparison of those
curative means, recommended as most salutary in the treatment
of any disease or class of diseases, that it is possible to assign
to each its peculiar advantages ; and as the situation of physi-
cian to the Belfast hospital, which I have held for several years
past, has afforded me every facility of studying practically pul-
monary affections, I now think it right to submit to the pub-
lic a brief account of the result of my experience. ‘The situation
of Belfast is remarkably low, and also extremely damp, so that
70 Dr. Little on the Treatment of Diseases of the Lungs.
those pulmonary affections, common to such situations, prevail
init, asmight be expected, toa very considerable extent. Pul-
monary consumption is certainly of very frequent occurrence
here, but that disease is, in all probability, favoured as much
by the numerous manufacturing establishments, as by the damp-
ness of the atmosphere. I am led to believe that acute nflam-
matory diseases do not prevail in a greater degree in Belfast,
than in less damp situations during the winter months, but in the
spring months, owing to its not being, to any considerable de-
eree, defended from the East and North winds, which usually
prevail at that season of the year, I think acute pulmonary dis-
eases occur more frequently, than in almost any town of the
same extent with which I am acquainted.
In the treatment of no single class of diseases, has there
been greater diversity of opinion with regard to the most suita-
ble curative means, than in that of the pulmonary organs ; some
practitioners trusting almost exclusively to one plan of treat-
ment, and others, again, relying on that of an opposite nature.
This, however, is only what has always been the case, in a cer-
tain degree, when the nature of the disease is, as im many
instances, incapable of improvement. There are some pulmo-
nary affections that are scarcely susceptible of palliation when
they have arived at a certain stage, but there are others, again,
at all times capable of receiving the greatest benefit from suita-
ble remedies. I therefore think it would be quite unreasonable
for any physician to recommend the same plan of treatment to
be exactly followed, under all the changes that this dangerous
class of diseases is liable to present ; and although it is my inten-
tion, in this paper, to dwell most on the advantages of counter-
irritation, still, it will be seen, that I am not insensible to the
sreat benefit of other means.
Turpentine is the counter-irritant I employ most in the
treatment of pulmonary affections, more particularly in those of
the air tubes, and as it is one that has not been hitherto re-
commended, as far as I know, to any considerable extent in
Dr. Little on the Treatment of Discases of the Lungs. 71
these diseases, I will take as extensive a view as possible of its
peculiar advantages, when compared with other remedies of the
same class.
I was first led to the extensive application of turpentine to
the chest in pulmonary affections, from what I knew respecting
its advantages, as an antispasmodic and counter-irritant in other
diseases: and I found on each trial the most satisfactory re-
sults as to its advantages in soothing morbid irritation, and at
the same in subduing (in proportion to the extent and duration
of its application) internal diseased action. ‘The two counter-
irritants in most common use in the treatment of pulmonary
diseases, are tartar emetic and cantharides. Now with regard
to these, no person can deny, but that they are both capable
of producing powerful irritation on the parts to which they
are applied. This, however, is not exactly all that is re-
quired in the treatment of pulmonary disease, but more parti-
cularly in that of the air tubes, when there is much acute in-
flammatory action present. The irritation of the surface, unless
that irritation gives rise to a change in the sensibility of the
respiratory muscles, cannot in these affections be productive of
more than partial benefit, for in all cases where the respiratory
organs are in a state of acute inflammation, there is spasmodic
action of the muscles immediately connected with these or-
gans, but more particularly those of the air tubes, and it is
very common to find cough, which is merely a spasmodic action
of these parts, continue for a considerable time after all inflam-
matory action has been completely overcome, so that whatever
counter-irritating application is used in these cases, should have
also, if possible, an antispasmodic effect. I certainly do con-
sider the antispasmodic powers of the turpentine application
in pulmonary diseases, of the greatest consequence ; but keep-
ing that effect out of view altogether, I would prefer it as a
counter-irritant to any other with which I am acquainted.
Sometimes pulmonary diseases are accompanied with great
local and general excitement of the system, and at other times
72 Dr. Little on the Treatment of Diseases of the Lungs.
the very reverse of this is the case,—there is great local and ge-
neral debility. Now I am quite convinced, from much expe-
rience in the application of turpentine as a counter-irritant,
that it may be carried to any reasonable length, without the
least danger of either increasing internal inflammatory action or
fever in these cases; or internal or general debility. Tartar
emetic is much too slow and too irritating an application, when
the pulmonary organs are in a state of acute inflammation, and
the application of a blister to the chest is of very doubtful
efficacy, even when blood-letting has been premised. I am quite
convinced, when these organs are in a state of acute inflamma-
tion in children, that blisters are, in nine cases out of ten, more
injurious than useful. But such is not the case with the ap-
plication of turpentine, no matter whether blood-letting be pre-
mised or not. The vascular system in children is very easily
roused, and this is a thing that I fear is generally kept too
little in view, in the treatment of the internal inflammatory af-
fections which I have been considering. When turpentine is
applied freely to the chest of a child, labouring under acute
pulmonary disease, it soon excites inflammation of the skin,
but this excitement of the skin is not immediately succeeded by
increased frequency of pulse, and increased difficulty of breath-
ing, as is frequently the case after the application of a blister ;
but, on the contrary, brings down, in proportion to the external
excitement that is produced, the frequency of the pulse, and at
the same time affords relief to all the internal inflammatory
symptoms. I am therefore well satisfied, that the proper ap-
plication of turpentine to the chest will be found in many cases
of pulmonary inflammation, but especially in that affecting the
air tubes, infinitely more useful than either tartar emetic or
blisters, on account of its antispasmodic as well as its stimulat-
ing effects. I would not merely give a preference to turpentine
over all other stimulants when applied to the chest, in acute
inflammation of the pulmonary organs, but would prefer it much
in those of a chronic nature; because it has no tendency
Dr. Little on the Treatment of Diseases of the Lungs. 73
like the others to increase debility, both local and general,
a too common accompaniment of such affections. I am quite
convinced, that the purulent discharge that is frequently kept
up in these cases by means of tartar emetic and blisters for
weeks, nay, sometimes even for months at a time, is productive
of the very worst effects in certain cases. When any chronic pul-
monary affection has subsisted for a length of time, the system
generally is brought to a state of debility, and it is, in nine
cases out of ten, making bad worse to bring it down by any
curative means still lower. I think I have seen in old age in
particular, when the system is altogether m a state of great
debility, the worst possible effects from the application of blis-
ters. I have seen, for instance, the bronchial secretion sud-
denly increase so much by their application, as to give rise
to suffocation, and I am certain I have observed the same
thing occur in infancy and childhood repeatedly. I have how-
ever, applied turpentine to the chest as a counter-irritant at
all ages, and in the lowest states of the system, and I can safely
say, I never saw any debilitating effects produced by it, no mat-
ter to what extent it was carried.
For some time past, the inhalation of chlorine and iodine
gases has been much extolled for the cure of chronic affections
of the air tubes of the lungs; and the inhalation of the same
gases has been even strongly recommended by medical men of
great respectability, for the cure of pulmonary consumption. I
have given avery extensive trial to these gaseous inhalations,
and I am sorry to say, that they have not proved so successful
in the cases where I have tried their curative powers, as I had
expected from the very strong manner in which they had been
recommended by many individuals to public notice. I have
certainly found these gaseous inhalations of use in chronic af-
fections of the air tubes of the lungs, but again I have found
them, by their stimulating effects on the mucous lining of the
same tubes, convert a chronic affection into one of an acute
kind. The difficulty in the use of these gases is the regulation
VOL. Vv. NO. 13. L
74 Dr. Little on the Treatment of Diseases of the Lungs-
of their stimulating effeets, and this is a thing that is quite im-
possible to do, even after the most extensive experience in their
use. In pulmonary consumption, I have never been able to
cure, or even relieve a single case by their use, and I have found
them, even in many eases, produce so much excitement, as to
render it necessary to discontinue their further application.
With respect to the comparative merits of these gases, the one
has always appeared to me to be possessed of nearly the same
effects as the other, both in consumptive cases, and also in cases:
of chronic inflammation of the air tubes of the lungs.
Although I consider the inhalation of chlorine and iodine
not by any means safe, or generally useful, and although I do not
consider any other counter-irritant to be at all compared with
turpentine in the treatment of pulmonary affections, still 1 do
not wish to be understood as advocating the exclusive use of
that application ; and in order to point out its advantages clearly,
and at the same time to explain the various auxiliary remedies
I frequently employ in conjunction with it, I will now proceed
to give a full detail of the various pulmonary affections in whick.
I have found it most beneficial.
Hooping cough is one of those epidemic diseases, from
which most children suffer an attack, and that before they have
arrived at their tenth year. It is unfortunately onthe pulmonary
organs more particularly, that this epidemic disease commits
its ravages: every person who has watched the progress of
hooping cough, must admit that it owes its peculiar characters,,
in a great measure, to spasmodic action of the muscles of
respiration, but more particularly those surrounding the aper-
ture of the larynx. There is, however, in addition to this spas-
modic action, almost alwavs a congested state of the mucous:
lining of the air tubes: this, however, appears always in the
first instance, to be greater about the larynx than any other part.
Sometimes, instead of what might be denominated a simple
congestion of the mucous lining of the air tubes, there isa more:
active inflammatory state, and this is even occasionally found to
Dr. Little on the Treatment of Diseases of the Lungs. 75
pervade the substance of the lungs. Now in this disease, the ©
danger would appear to be partly owing to spasmodic action,
and partly to inflammatory action, the former being most dange-
rous in very young infants, and the latter in children of all ages,
possessing full habits of body. From these circumstances, the
physician should keep two things strictly in view in the treat-
ment of hooping cough, the one is the reduction of spasmodic,
and the other that of inflammatory action.
I do not know any single remedy in which I could place so
much confidence, in the treatment of this disease, as the appli-
cation of turpentine, owing to its antispasmodic and counter-irri-
tating effects, when used freely to the surface of the chest or
throat. In all cases, after the chest or throat has been freely
moistened with the turpentine, a piece of flannel should be closely
applied, so as to exclude all access of air, and at the same time
assist in keeping up the irritation on the surface. When it is
deemed necessary to increase the antispasmodic powers of the
turpentine, a proper proportion of camphor or laudanum 1s ad-
ded. I have seldom found it necessary to repeat these appli-
cations more than once or twice a day, unless the symptoms
were very urgent, so as to require active counter-irritation. In
addition to the turpentine application in the treatment of hoop-
ing cough, [ invariably detract blood from the chest or region
of the larynx, when I find any feverish state, pain of chest, hur-
ried breathing, or any other symptoms indicating inflammatory
action in the air tubes or substance of the lungs. Inchildren of
full habits, I employ leeches, independently of the pressure of
inflammatory symptoms. When leeches are applied in hooping
cough, the bleeding should never be promoted by sponging with
warm water after they are detached: it is better, instead of
sponging in this way, to apply as many leeches as will be equal
to take away the quantity of blood required, so that there may
be no exposure of the parts after their removal.
By proceeding with the applications I have just stated,
and at the same time attending to the state of the bowels, I ge-
76 Dr. Little on the Treatment of Diseases of the Lungs.
nerally find the spasmodic cough, and all the other morbid
symptoms which usually accompany the disease I have been
considering, subside, even in the worst cases, in the course of
eight or ten days. Internal antispasmodics of different kinds,
are very generally employed in the treatment of hooping cough.
I have tried a very great variety of remedies of this class, and I
must candidly confess, that they have, inalmostall cases, very much
disappointed me; but although I cannot recommend them as
being equal in efficacy to the turpentine application, still there
are some of them useful auxiliaries to it in the relief of the spas-
modic cough. The internal antispasmodics which are most
useful, are opium, hemlock, and henbane, in the form of tinc-
ture, either given separately, or in combination with each other,
and with a suitable proportion of hippo or antimonial wine. At
the commencement, and even during the entire progress of
hooping cough, it is very common for physicians to order squills
in doses sufficient to excite vomiting several times daily ; now
this, [ think, is a most reprehensible plan of proceeding, on ac-
count of the great tendency it has to produce, in some instances,
and in others to increase, inflammatory congestion of the mucous
lining of the air tubes of the lungs, a thing that the practitioner
should take particular care to prevent or remove. Those who
order squill emetics, generally do so with the view of promoting
the discharge of a quantity of the phlegm which usually abounds
so much in this complaint. The removal of the phlegm is cer-
tainly a thing most desirable, but it should be remembered that
this secretion is merely a product of the spasmodic and inflam-
matory action which I have stated as constituting the complaint,
and that it can only be moderated or checked by antiphlogistic
and antispasmodic remedies.
When hooping cough is not treated on the antiphlogistic
and antispasmodic plans I have so strongly recommended, it
sometimes assumes a chronic character, and the child becomes
hectic: now when such is the case, change of air is recom-
mended, and in many instances, this is productive of the very
Dr. Little on the Treatment of Diseases of the Lungs. 77
best effects. I am so much alive to the immense advantages of
_ certain states of the atmosphere, to the recovery of children af-
“fected with this disease, that I would, if possible, keep them
breathing from its very commencement, in tolerably moist air,
at a temperature never lower than sixty-six degrees of Fahrts
thermometer.
Asthma.—This is another disease that is characterized by
great spasmodic action of the respiratory muscles, but more par-
ticularly those of the air tubes. It is, however, only as far as
spasmodic action of the respiratory muscles is concerned, that it
bears any resemblance to hooping cough, for as to its exciting
causes, general symptoms, progress, and termination, it is totally
dissimilar to the last mentioned disease. In asthma, the mu-
cous lining of the air tubes of the lungs is sometimes perlectly
healthy, and at other times it is in a diseased condition, or at
least it possesses, in some individuals, a strong predisposition to
assume a diseased action, on the slightest application of cold to
the surface of the body, or the least change in the temperature
of the atmosphere ; and: hence, sometimes, those paroxysms of
difficult breathing which constitute the asthmatic attack, are ac-
companied with bronchitis, either in a lesser or greater degree.
It would appear, therefore, from these circumstances, that in the
treatment of asthma, as far as the paroxysm is concerned, some-
times antispasmodic remedies alone will be sufficient, and at
other times that these must be combined with such as are pos-
sessed of antiphlogistic powers.
I have tried freely antispasmodics of the most powerful kind,
in this disease, as internal remedies, and from landanum, which
is one of the most powerful of them, I have even been fre-
quently unable to procure any immediate relief from the difti-
culty of breathing. And with regard to diffusible stimulants,
either alone or combined with laudanum, I have in many in-
stances been little more successful; but such has not been the
case when I have employed to the surface of the chest, the tur-
pentine application, until it has produced considerable “inflam-
78 Dr. Little on the Treatment of Diseases of the Lungs.
mation. In order to excite sudden inflammation on the surface
of the chest with this application, it should be used as hot as
it can be borne, and by means of flannel, I have in very few cases
failed to check an asthmatic paroxysm by the application IJ
have just stated, in one or at most two hours. I do consider it,
therefore, after numerous trials, by far the best antispasmodic
that the physician can make use of in the disease in question.
When there is either temporary or permanent disease of the
mucous lining of the air tubes of the lungs, in addition to spas-
modic action of the internal respiratory muscles, as is the case
in what is denominated humoral asthma, I would employ once
or twice every day, unless too much external inflammation were
produced, the turpentine application to the chest, and at the
same time, if the disease of the mucous lining of the air tubes
were of the inflammatory kind, I would apply leeches as an
auxiliary. I wish it to be distinctly understood, that I would
in the treatment of spasmodic asthma, either of the purely ner-
vous or humoral kind, use occasionally other remedies in addi-
tion to those I have just recommended, for it is of all other
diseases, one that would require nearly all the resources of the
physician.
An attack of asthma is generally produced by a disordered
state of the system, of greater or less duration, so that there is
time to apply the turpentine freely to the chest, before the
spasmodic breathing commences. When the turpentine is em-
ployed for the%purpose of preventing the occurrence of a pa-
roxysm of asthma, it should be applied to the entire chest by
means of flannel, and at as high a temperature as it can be
borne by the patient, for unless there is very extensive redness
and smarting produced, it will not answer the purpose.
Croup is an inflammatory affection of the air tubes of the
lungs, extending in most cases from the larnyx to the ex-
treme ramifications of the bronchie. It is the mucous lining
that is more particularly affected in this complaint, but there
is also very considerable spasmodic action of the internal res-
Dr. Little on the Treatment of Diseases of the Lungs. 79
piratory muscles, so that it should be always considered as a
disease partly consisting of acute inflammation, and partly of
spasmodic action. Thisis a disease peculiar to infancy and
childhood, and like many other maladies of these periods of
life, it runs its course with great rapidity, and very frequently
to a fatal termination. It requires, therefore, that whatever re-
medies are employed for its treatment, should be possessed of
considerable activity, both for the relief of inflammation and
spasmodic actions. The plan I usually follow, in the treatment
of croup, is to detract a quantity of blood as soon as possible
after its commencement, the quantity of blood always to be in
proportion to the state of the system and the violence of the
disease. When children are very young, or not possessed of
very strong constitutions, I would prefer the detraction of blood
from the chest or throat by means of leeches, and when chil-
dren are from eight to ten years of age, I would employ the
lancet. After the free detraction of blood, the next step is the
production of counter-irritation over the chest and neck by
means of the turpentine application. When the turpentine has
produced a considerable degree of cutaneous inflammation, I
generally find the dry barking cough considerably relieved,
and by a little further perseverance, all the morbid symptoms
subside. Besides this application and the blood-letting, I in-
variably, at as early a stage as possible, establish perspiration,
which I keep up freely, at the same time that I employ the
turpentine to the chest and throat. As a diaphoretic I gene-
rally prefer an infusion of hippo, to which I add a small quan-
tity of nitre and henbane. The strength of this infusion must
vary according to the age of the child, and the effect that is
required, ‘The dose should always be such in the first instance,
as to give rise to a considerable deal of nausea, but at the same
time, care should be taken not to carry it so far as to excite
vomiting. In the treatment of all acute affections of the respi-
ratory organs, sweating is a remedy of the greatest importance.
It requires, however, to be kept up for several hours at a time,
80 Dr. Little on the Treatment of Diseases of the Lungs.
in order that it may be useful, and I do not know any one dis-
ease of this class, in which its curative powers are greater, if
carried a sufficient length, than that of ‘inflammatory croup.
‘The salutary effects of sweating remedies are seldom or ever
obtained by the common plan of conducting that process ; for
instead of keeping the skin moist for one or two hours, as is
usually the case, it should be kept freely moist for fifteen or
twenty hours. Bleeding, early counter-irritation with turpen-
tine, and free sweating, are the remedies on which I would al-
most exclusively rely in the treatment of croup, not forgetting,
at the same time, the necessity of keeping the bowels free with
cooling laxatives. By some practitioners calomel is thought to
possess wonderful powers, when given to a considerable extent
in croup, I have used it it in many cases of this complaint to a
very great extent, and again I have used it in smaller quan-
tities, and from the numerous trials I have made of its curative
powers, I do not think it is a remedy that can be at all de-
pended upon, no matter in what dose it is given. I could
therefore wish, that the use of this medicine were dispensed
with altogether in the treatment of inflammatory croup.
There is no acute affection of the respiratory organs more
liable to suffer a relapse, than the one I have just been con-
sidering, so that it is necessary during convalescence to guard
against any exposure to cold. In order to prevent any bad
effects from exposure to cold, I would advise during the conti-
nuance of the acute symptoms, and even for some weeks after
these have subsided, that the patient be kept constantly in an
atmosphere such as I have stated to be most useful in hooping
cough.
Bronchitis.—This is a morbid affection of the respiratory
organs, of still more frequent occurrence than any of these I
have hitherto considered, and as it is produced by atmospheric
changes, particularly from heat to cold, it merits, m a variable,
damp climate such as this, the very particular attention of the
medical practitioner. In Belfast I am convinced that colds
Dr. Little on the Treatment of Diseases of the Lungs. 81
prevail more than all other pulmonary affections, and as they are
frequently complicated, in this and all other places where they
prevail to a great extent, with many other morbid conditions of
the system, they are the immediate cause of death in far more
cases than is generally supposed. Bronchitis, being a disease
that attacks at allages, and even in the most opposite conditions
of the system, requires far more attention than almost any other
disease of the respiratory organs, as far as treatment is con-
cerned. Its progress in infancy, childhood, manhood, and old
age, are all different, and it therefore requires, at each of these
particular periods of life, remedies in some degree different
from those that would be suitable at any other period. All the
eruptive fevers are accompanied with a bronchial affection, and
this is in many instances of a very dangerous kind; but that
which is so generally complicated with continued fever in the
winter season, is productive in very many instances of the most
disastrous consequences. This, however, is more particularly
the case in those who are advanced in life, or who are possessed
of delicate constitutions. I might safely say, that the one-half
of those who die of fever in the Belfast hospital, being ad-
vanced above thirty-three years of age, die from asphyxia, in
consequence of disease of the mucous lining of the air tubes of
the lungs. Although bronchitis, complicated with fever, is not
so dangerous in manhood or childhood as in old age, still at the
two former periods of life, it is not by any means to be con-
sidered as a trifling morbid affection, when complicated with
that disease. I fear it is too much the case in the treatment of
continued fever, to look upon bronchial disease as a secondary
affection of no great consequence. Such, however, should not
be the case, for at any period of life it is one of the most fre-
quent, insidious, and dangerous complications of fever with
which I am acquainted. This is the case particularly during
the winter and spring months.
In the treatment of bronchitis occurring at different ages,
and in different conditions of the system; I have found no single
VOL. V. No. 13. M
82 Dr. Little on the Treatment of Diseases of the Lungs.
plan of treatment at all to be compared with that of counter-ir-
ritation of the surface of the chest, by means of turpentine. The
antispasmodic powers of this application are of the greatest
consequence, when the respiratory muscles are in a state of ir-
ritation, and such is the case in the disease of the mucous
membrane I am just considering, to a very great extent. It is, —
besides, an application that as I have already stated, is not
hable either to increase the bronchial inflammation, or the ac-
companying symptomatic fever, as is too often the case with
blisters and other stimulating applications, so generally applied
to the chest in cases of bronchitis. In the treatment of acute
bronchitis occurring in youth or middle age, and not accompa-
nied with continued fever, I would advise, next to the detrac-
tion of blood, free counter-irritation of the surface of the chest
by means of flannel well moistened with turpentine, and ct the
same time copious sweating for several hours. In slight attacks
of cold I would never think of bleeding, but trust simply to
the turpentine application to the chest, free perspiration, and
keeping the bowels free by means of some cooling laxative.
In the treatment of acute bronchitis in children, there should
never be a large quantity of blood abstracted either by the
lancet or leeches, even in the most severe cases, on account of
the sudden and dangerous relaxation it is liable to produce in
such patients. The safest and most successful plan of treating
bronchitis in children, consists in early and moderate bleeding,
early counter-irritation with turpentine, and early and free
perspiration, together with the use of the mildest laxatives.
When acute bronchitis occurs in old age, the application of
turpentine to the chest so as to excite cutaneous inflammation,
together with mild diaphoretics and gentle laxatives, will, at an
early period of the disease, afford by far the best chance of
success. Blood-letting is a remedy that I would not at all re-
commend, and it is, in my opinion, in most cases very danger-
ous, when inflammatory action of the mucous lining of the air
Dr. Little on the Treatment of Diseases of the Lungs. 83
tubes of the lungs occurs in a relaxed state of the system, which
is almost always the case in persons far advanced in life.
The acute bronchitis which occurs so frequently in this
town, in connexion with continued fever, should be treated in
almost all cases without the loss of blood, either by means of
leeches or the lancet. I do not know how the loss of blood js
borne for the relief of acute inflammation of the mucous lining
‘of the lungs in other places, but in this I am quite satisfied,
that it is a dangerous practice in nine cases out of ten jn con-
tinued fever. The great danger from the loss of blood in bron-
chitis occurring in old age and in continued fever, is the pro-
duction of relaxation of the system to such a degree, as to give
rise to asphyxia, from the accumulation of mucus in the air
tubes. I would, therefore, in almost every case of bronchitis,
accompanied with continued fever, overcome the inflammatory
action by the early and free application of turpentine to the
chest. The use of sweating remedies, so valuable in the gene-
neral treatment of acute bronchial inflammation, is of some-
what doubtful efficacy in the treatment of that complicated
with continued fever ; and when bronchitis is accompanied with
the last mentioned disease, I would treat it in the great majo-
rity of cases by the turpentine application alone. It is neces-
cessary for medical men who take charge of patients labouring
under continued fever, to be most attentive to the state of every
internal organ of the body, and there is no part that requires
more attention than that of the mucous lining of the air tubes
of the lungs. As soon as I ascertain the existence of dis-
ease in the mucous lining of the lungs of persons labouring
under fever, I cause the chest to be well sponged with
turpentine, and to be afterwards closely covered with flannel.
The extent to which I carry the turpentine application varies
according to the amount of diseased action to be overcome.
In severe casesof inflammation, I would repeat the sponging
with the turpentine every second or third hour, and in more
mild cases I would not, in all probability, repeat it more than
84 Dr. Little on the Treatment of Diseases of the Lungs.
three or four times a day. In the treatment of chronic bron-
chitis, I find the free use of turpentine to the surface of the
chest, generally more decidedly useful, than any other external
application, or any internal remedy with which I am ac-
quainted, and it should, at least in that disease, always be
considered a necessary part of the curative means that are
employed.
From what has been said respecting the advantages of tur-
pentine as an antispasmodic and counter-irritant in bronchitis, ,
I need not dwell at any length on its employment in the
treatment of pneumonia and pleuritis. In the last mentioned
diseases, I employ it as a counter-irritant from the very com-
mencement of the inflammatory action, and with the very best
effects. When it is desirable to excite by the turpentine ap-
plication to the chest sudden cutaneous inflammation, it 1s
used at as high a temperature as the patient can bear it, and by
means of flannel. The plan I follow in most cases in the
treatment’of pneumonia and pleuritis, when the person is of a
strong constitution, is to detract blood freely at as early a stage
as possible, and at the same time excite sudden and extensive
inflammation on the surface of the chest by means of warm
turpentine. ‘The only other remedies I use in addition to these
are diaphoretics and cooling laxatives.
Before I conclude this paper, I cannot omit making a few
observations on the treatment of pulmonary consumption, which
is a disease of very frequent occurrence, and at the same time,
one that is less easily managed than any of these diseases
of the pulmonary organs I have hitherto considered. ‘The
number of cases of pulmonary consumption constantly under
my care in the Belfast hospital, is very great, so that I have
an extensive opportunity of treating it at every stage. It is
precisely the same with consumption, as it is with all other
diseases of the pulmonary organs, the physician can do most
good, when he is consulted at an early stage, and by the assist-
ance of the stethoscope, he will be able, in the great majority
of cases, to detect the presence of tubercles in the lungs, before
Dr. Little on the Treatment of Diseases of the Lungs. 85
they have made much progress. There was a time when the
cough, which is usually produced by the presence of tubercles
in the lungs, at a very early period of their growth, was, in
most instances, attributed to bronchial disease, and hence its
real cause was not, in all probability, discovered, until very ex-
tensive disorganization of the pulmonary substance had taken
place.
In the treatment of pulmonary consumption at an early stage,
the”physician has two important objects to fulfil, by whatever
curative means he may employ ; the one is to promote the ab-
sorption of the tubercles, and the other is to retard their growth
as much as possible. I do not know any thing so useful for
the purpose of promoting the absorption of tubercles, or re-
tarding their growth, as frequent small bleedings, and coun-
ter-irritation to the chest by means of turpentine. I prefer the
application of a small number of leeches to the chest, to any
other mode of detracting blood: the number, in persons of full
habit, should never exceed eight at a time, and the bleeding
from the bites should never be promoted by sponging with
warm water. ‘The best way of proceeding, after the leeches are
detached, is to cover the bites with adhesive plaster, and im-
mediately afterwards, apply over the entire chest, a piece of flan-
nel, well moistened with turpentine. In young persons of pretty
full habit, six or eight leeches may be applied] to fthe chest
twice a week, and in persons of rather delicate constitution, the
same number may in general be applied with advantage once a
week. The best time to apply the turpentine to the chest in a
general way, is at bed time, and one good application at that
time, will generally be quite sufficient to keep a slight, but con-
stant irritation on the surface.
By proceeding with the bleeding and application of the
turpentine in this way, I have, in several cases, when I had eve-
ry reason to believe that tubercles were in considerable number
in the lings, been able to remove, completely, the symptoms of
pulmonary disease ; and again I have been able, by prosecuting
86 Dr. Little on the Treatment of Diseases of the Lungs.
the same plan with steadiness, to retard, in many cases, the
progress of the disease.
In all cases where there are either tubercles present in the
lungs, or a strong tendency to their development, the greatest
advantage is gained by defending the surface of the chest from
cold during the winter season. The chest may be defended
from cold in various ways, but I think there is nothing that an-
swers the purpose better, than a very thin layer of cotton wool,
fixed in such a way, as not to be liable to shift by the different
motions of the body. The application of blisters to the chest,
is in very general use at the commencement of pulmonary con-
sumption, for the purpose of affording relief to the pain of
chest, cough, and other early symptoms. Iam convinced, how-
ever, that instead of affording relief, these applications, in very
many cases, hurry on the disease to a fatal termination, owing
to their excessive irritation, favouring, instead of retarding the
secretion of the tubercles. Besides, blisters, if frequently re-
peated, have the effect, in most cases, of producing great gene-
ral debility, a thing that should be avoided as far as possible, in
every stage of the disease. ‘The debility, and excessive irritat-
ing effects produced by the protracted use of tartar emetic to
the chest, renders it also an objectionable remedy. There isone
stimulating application, besides the turpentine, that I have used
to a very considerable extent, in the treatment of the first stage
of pulmonary consumption ; it is iodine ointment. This appli-
cation, however, aswell as that of the turpentine, must beattended
with leeching. . With regard to the use of internal remedies in
the first stage of pulmonary consumption, I know none on which I
could place more confidence. When the cough is very trouble-
some, however, the antispasmodic power of the turpentine may
be assisted by hemlock, hyosciamus, and hippo, combined toge-
ther, and given in proper doses.
It is certainly necessary at the commencement, and even
during the entire progress of pulmonary consumption, to attend
to the food, drink, and above all, to the keeping the body in
Dr. Little on the Treatment of Diseases of the Lungs. 87
an equable, and at the same time, moderately high temperature.
These, however, are only auxiliary to the plan of treatment I
have so strongly recommended.
With respect to the advanced stages of consumption, I need
say nothing, as, after the progress of softening has commenced
in the tubercles, the physician can scarcely palliate the various
distressing symptoms. There is, however, in the progress of
consumption, an affection of very frequent occurrence, that merits
a little attention, it is pleuritis. The pleura, when inflamed,
produces most acute pain ; and when attacked in the last stage
of consumption, has a most distressing effect. Now for the
relief of pleuritis, under such circumstances, the turpentine ap-
plication will be found most valuable, on account of the sudden
relief it affords. |
I intended, at the commencement of this paper, to illustrate
the advantages of turpentine in the treatment of pulmonary. af-
fections, by a number of cases; but I found, before I had. pro-
ceeded far, that such a plan would have rendered it far too
voluminous. |
EXPLANATION OF PLATE.
This plate exhibits an accurate representation of the calculi
removed by Dr. G. O’Brien. (See Case II. p. 8, of this Num-
ber.)
Fig. I. Represents the calculus first extracted, and which broke
before being removed. The tooth is seen with the fang
turned upwards, the crown being fixed in the calculus: the
appearance of the enamel is quite distinct. The fissure be-
neath marks the commencement of the fracture, where the
stone broke.
Fig. I. The calculus subsequently obtained. The superior,
extremity exhibits the fang of the tooth, protruding, as it
was seen, after some of the matter had been scraped away.
Fig. Il]. A section of this calculus, shewing the situation, and
the several parts of the tooth within. The fang, crosmn;'! as é
and enamel, are distinctly marked ; with the canal, contaits ~
ing a substance, that appears to be the remains of the
nerve.
These representations are of the exact size of the originals.
DUBLIN MEDICAL JOURNAL
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BIBLIOGRAPHIC NOTICES.
Observations on Obstetric Auscultation, with an Analysis of
the Evidences of Pregnancy, and an Inquiry into the Proofs
of the Life and Death of the Foetus in Utero. By Evory
Kennepy, M.D., Licentiate of the King and Queen’s College
of Physicians in Ireland, Lecturer on Midwifery and the Dis-
eases of Women and Children, at the Richmond Hospital
School, and late Assistant to the Dublin Lying-in Hospital.
(Continued from Vol. IV. ». 265.)
WE now come to a most important part of Dr. Kennedy’s work,
the application of auscultation, as one of the evidences of preg-
nancy, and of the means of ascertaining the life or death of the
foetus in utero. In some of the most difficult and doubtful cri-
ses which occur in midwifery, a knowledge of the life or death
of the foetus may often save the life of the child or mother, and
will always materially influence, and to a great degree guide,
the practitioner in the performance of one of the most revolting
operations in medicine.
The discovery of auscultation, as a means of diagnosis in sus-
pected pregnancy, is due to Maior of Geneva, who heard the
action of the foetal heart, by applying his ear to the abdomen of
a pregnant woman. Kergaradec put this discovery into prac-
tical application, and detected the placental soufile; and the
attention of the profession in this country was, we believe, first
called to the value of auscultation in doubtful pregnancy, by two
papers, published in the Medical Transactions, and Dublin
Hospital Reports; the first by Dr. Ferguson, Professor of Prac-
tice of Medicine to the Apothecaries’ Hall of Ireland, the second
by Dr. Kennedy, the author of the work before us.
Dr. Kennedy, in combating the objections to the use of the
stethoscope, notices a German writer, Siebold, who asserted,
that notwithstanding all the pains he took, he was unable to dis- .
cover any sound with the “hearing trumpet,” as he calls the
stethoscope. Siebold, however, admits that he could easily de-
VOL. V. No. 13. N |
90 Bibliographic Notices.
tect the required sounds with the naked ear, while Dr. Jobn-
son, of Edinburgh, inthe ninth number of this Journal, speaking
for himself, and, as he states, authorized to the same purport
by others, assures us he could never hear the foetal heart, and
modestly says, that he does not believe the assertion of a re-
spectable member of the profession, as to Ais ever having heard
it. We should like, as a curiosity, to have a statistical table of
the ages of the disbelievers in auscultation. We would venture
a wager, that as in the instance of the sceptics on Harvey's
discovery of the circulation, their ages would average above 40,
unless, perhaps, with an exception of insuperable ignorance or
self-conceit that scorns to learn. Within the circle of our own
observation, we have observed men holding a respectable rank
in the profession, who first publicly sneered at what they
called the quackery of the stethoscope, then prophesied that
its use as a toy would not outlive a year, next became silent on
the subject, and now, with more cunning than honesty, carry the
instrument about with them, pretending to understand its ap-
plication, and knowing as much of its use as a state trumpeter
in one of our city pageantries, knows of the use of the instru-
ment of music which he idly carries as part of the show.
When an individual comes forward, and stating himself as
speaking the sentiments of a number, says that the persons on
whose part he speaks could not believe that “ the foetal heart
is audible before birth,” we have only one of these alterna-
tives to offer, either, Ist, that the individuals on whose part he
speaks, are all deaf, forming a party brought together by a freak
of accidents, like the party of dervishes in the Arabian Tales all
blind of an eye, or 2dly, that having the possession of the fa-
culty of hearing, they will not exercise it, and there are none so
deaf as those that wild not hear; or lastly, that all those in
France, Germany, Italy, and our own countries, who say they
can hear and have heard the foetal heart, are all linked toge-
ther to uphold an imposture. The last supposition 1s too
monstrous to be entertained for a moment: the first, Dr. John-
son and his supporters will, from their self-esteem, at once re-
pudiate. In possession of the second, the only remaining alter-
native, we leave them in the full enjoyment of all their self-gra-
iulations.
The placental souffle, or sound produced in the neighbour-
hood of the placenta, is the first sound noticed. ,
‘¢ If we examine, either with the naked ear or the stethoscope,
the abdomen of the pregnant woman, we shall (provided the preg-
nancy be sufficiently advanced) observe a peculiar blowing or hissing
spun This sound is to be met with in almost every case, and is
Dr. Kennedy on Odstetric Auscultation. 91
observed at different parts of the uterine tumour. It does not al-
ways exhibit the same characters ; yet these are sufliciently striking
to render it recognizable in almost every case. It assumes the dif-
ferent varieties which Laennec describes under the term bellows’
sound, namely, the bellows’ sound, properly so called, likened by
that author to the continuous murmur, similar to that of the sea,
familarly exemplified by the application of a large shell to the ear;
the rasping or sawing sound, which is occasionally found so exactly
imitated as to lead, the listener to imagine an artisan at work quite
close to him; and the musical or hissing sound, so well described.
by the same author. A sound, resembling the cooing of a dove, is
sometimes observable, but this is comparatively rare. A more fre-
quent peculiarity to be noticed, is, a strange drone resembling that
of a bagpipe accompanying the sound, but yet without interfering
with it. The most constant form we meet with, however, is a com-
bination of the bellows or sawing with the hissing sound, com-
mencing with one of the former, and terminating with the latter;
and this is in general so protracted, that the last souffle is audible
when the subsequent one commences.
‘‘ These sounds are, from the distention of the uterus, and con-
sequent facility of examination, easily detected in advanced preg-
nancy ; and although not so loud or sonorous in the earlier stages,
yet to the practised ear they become equally distinct. None of the
above mentioned varieties are peculiar to particular stages of preg-
nancy, being detected indifferently in them all. The extent of sur-
face over which the sound is observable, varies much according to
circumstances ; in some it is confined to a small circumscribed spot, in
others it is audible over a greater surface, perhaps two or three inches
square ; and in a few it is to be met with over the greater part of
the uterine tumour, although there is in many cases one spot in par-
ticular, perhaps not larger than the end of the instrument, where
the sound is vastly more distinct and sonorous than elsewhere. The
soujjle is most frequently found in the lateral and inferior parts of
the uterus, but it may have its seat in any part of it; and it must be
added, that cases will occur, although, if proper precautions be had
recourse to, very rarely, where we shall not be able to detect it.
‘The cause producing the sounds in question requires explanation,
with a view to which, we must briefly inquire into the nature of the
vascular structure and circulation of the uterus.”
Dr. Kennedy examines the structure of the uterus where
the placenta is attached, to explain the production of the souffle.
He observes, that the portion of the uterus to which the pla-
centa isattached, is a circumscribed portion, changing abruptly
from the remaining texture of the uterus, and consisting of “a
congeries of vessels, tortuous, ramifying, and expanding into
cells or sinuses, whilst the remaining part exhibits the parenchy-
matous structure of this organ, with merely occasional vessels
interspersed.”
92 Bibliographic Notices.
After an examination of the facts observed relative to the
placental souffle, and a repetition of De Haiis’s opinion, that
the sound is in the aorta or iliac arteries, our author states
his own conclusion, that the souffle depends on the transmission
of blood through the arterial tubes of the uterus.
The immediate cause of the production of souffle is next
discussed, and Dr. Kennedy adopts the explanation of its pro-
duction offered by Dr. Corrigan.
‘The manner in which the souffle, when situated in the other
arteries of the body, is produced, does not as yet appear to have been
quite agreed upon. Laennec, after discussing the subject at con-
siderable length, arrives at the conclusion that it depends upon
spasm. Dr. Corrigan ascribes the phenomenon to the currents pro-
duced by the passage of blood from a narrow orifice into a wider
tube. It certainly appears more reasonable to explain what we may,
with propriety, at least in the instance of placental souffle, term a
constant phenomenon, upon the principle of fixed physical causes,
than that of spasm, which we can only term a casual and changing
vital operation ; but besides this, Dr. Corrigan’s views would rather
appear to be corroborated by the phenomenon in question. Let us
bear in mind the difference that exists between the virgin and the
pregnant uterus. That, in the latter, a new system of vessels be-
comes rapidly developed, capable of furnishing with the means of
growth a new being, and the appendages peculiar to it. The organ
which heretofore received merely a sufficiency of blood to sustain its
own vitality, and admit of a slight periodic discharge, in consequence
of the alteration in size which has taken place, and as well the com-
parative increase in the vessels already existing as the development
of new ones, now receives a quantity of blood, bearing a very large
proportion to that circulating in the rest of the system, while the
great vessels supplying this organ do not appear sensibly altered in
size. With this view of the circulation we can find no difficulty in
admitting, that between this system of vessels and the main trunks
supplying it, a disproportion in calibre exists. If we take into con-
sideration with this the peculiar distribution of the vessels of the
uterus at the placental part, and the free anastomosis which takes
place here and in the lateral parts, the vessels meeting and converg-
ing there, and that a comparatively small stream is now rushing from
one or two arteries into an extensive system of tubes, the aggregate
calibre of which is infinitely greater than that of the vessel or vessels
from which it flows ; the inference of Dr. Corrigan with regard to
bruit de soufflet generally, may with every justice be drawn,
namely, ‘ that the motion (of the blood) is that of a current; the
sides of the arteries, instead of being acted upon by a body of fluid
moving forward almost as a solid mass, receive the impulse of a
stream whose particles are in motion with different degrees of velo-
Dr. Kennedy on Obstetric Auscultation. vo
city.’ * The existence of the sound here, beyond the point where
the artery is comparatively narrow, tends, as in Dr. Corrigan’s expe-
riments, to prove its dependence upon the above causes.”
There are some very useful directions given on the means
of avoiding mistakes, which might be made by the tyro in the
use of the stethoscope, when seeking for the placental souffle.
For these we must refer to the work. It is scarcely necessary
to say, that Dr. Kennedy relies very much on the placental
soulile as an evidence of pregnancy.
‘“The co-existence of the foetal pulsation with the souffle, of
course decides the question ; but with regard to the latter, taken se-
parately, we shall even go so far as to say, that were all the symptoms
of pregnancy absent, and this sound could be distinctly perceptible,
we should at least withhold our opinion until a sufficient time had
elapsed to place the matter beyond a doubt.”
And two very convineing cases are given in support of this
opinion.
The placental souffle may be detected at a very early period
of pregnancy.
‘‘ We have not succeeded in detecting the placental sound in
any case until after the second month from impregnation ; but have
frequently done so in the tenth, eleventh, and twelfth weeks.
‘¢ August 15th, 1829.. A woman named Devereux, who had been
under my care in labour eighteen months before, called to consult
me for a slight attack of pneumonia. She mentioned that her
menses had not appeared for the last two months: I therefore ex-
amined her with the stethoscope, and detected clearly the placental
souffle, although no uterine tumour was observable. Dr. Collins,
who also examined her, expressed his astonishment at its distinct-
ness at that early period. I gave this woman reason to suppose it
possible that she was pregnant, of which she had not the slightest
anticipation. However, the accuracy of the diagnosis was attested
by her coming into hospital on the 7th of March, 1830, in labour,
and being delivered of a living child the day following, exactly
twenty-nine weeks from the period at which we had examined her.”
In concluding his observations on the placental souffle, he
observes judiciously as to the reasons for demanding confidence
in it.
“* Considering the souffle as an evidence of pregnancy, in an ab-
stract point of view, we should be inclined to inquire what ought
more strongly to verify the opinion we arrive at on this subject, or
* Lancet, vol. 1, N.S. p. 1.
94 Bibliographic Notices.
ailord us more assistance in our investigation, than a phenomenon pro-
duced by the passage of blood through the vessels constituting the
connexion between the parent and the embryo; on the supply of vi-
tal fluid, through which, however mysterious that connexion may
appear, the actual existence of the latter as an embryo, its develop-
ment as a foetus, and maturity as a child, depend ?”
The next auscultatory sign taken up is the pulsation of the
heart of the foetus.
‘“‘ In exploring with the stethoscope the abdomen of a woman at
the full period of pregnancy, whose child is alive, we shall detect over
a surface, more or less extensive according to the position of the
child, and disposition of the foetal and maternal organs, a pulsatory
sound generally much more rapid than the pulse of the mother, and
exhibiting the characteristic marks of a distinct and independent
circulation.”
The pulsations of the foetal heart are about 130 or 140, but
are considerably influenced by the state of the circulation in the
mother, by hemorrhage from the maternal vessels, by the muscu-
lar efforts of the foetus, and by the action of the uterus in labour.
Some interesting cases are related, illustrative of these points,
and very full descriptions are given as to the circumstances in-
fluencing the position of the foetal heart, and as to the rules
for discovering its pulsations.
The position of the foetal heart is never discovered so early
as the placental souffle ; the latter is occasionally detected as
early as the tenth week, while the foetal heart can only with
difficulty, and by an experienced stethoscopist, be discovered be-
fore the period of quickening. Those who, after a perusal of
the following case, can be content to remain ignorant of auscul-
tation, deserve to remain for ever in the bliss of ignorance.
“The author is indebted for the following case to his friend Dr.
Byrne, Physician to the University. ‘Mary M., ztat. thirty-four,
married, of a pale, leucophlegmatic appearance, the motier of three
children, of bad health for the last nine months; had no child for
the last three years; catamenia irregular for the same period, both
as to quantity and time of appearance. Has been much distressed in
mind of late, by a tumor rising out of the pelvis into the hypogastrium,
as she cannot satisfy herself with regard to its nature. ‘The physi-
cian under whose care she was, had an accoucheur to examine her
per vaginam, before my seeing her; who pronounced the case to be
one of a tumor, about the size of a clenched fist, growing from the
superior fundus of the uterus, and involving the fallopian tubes, and
ovaries : he further condemned it as cancerous, from a supposed no-
dulated feel, when examined through the parietes of the abdomen.
The treatment usual in cases of cancer had been resorted to, but
Di. Kennedy on Odstetric Auseultation. 95
without any good effect. On May 29th, 1830, I examined her, be-
ing requested to do so, in order to make myself acquainted with the
feel of cancerous tumors growing in this situation. Her present
symptoms are, occasional sickness of stomach, pains about the loins,
appetite bad, tongue clean, bowels free, pulse quick, weak, and small :
the catamenia have been suspended for five or six months. The tu-
mor is soft, elastic, and circumscribed, without pain on pressure, and
occupying the pelvis and lower part of the abdomen. I can find no
nodules on relaxing the abdominal muscles in the usual way ; but as-
certained that when these were in a contracted state, as in the sitting
posture, such a sensation was communicated to the hand in a slight
degree. On applying the stethoscope immediately below the umbili-
cus, I heard a masked murmur, very different from the borborygmus
of the intestines : on changing to the right side, on the same plane, the
placental murmur was tolerably distinct, but this sound singly was not
sufficient to make me pronounce on the nature of the tumour. On
removing the instrument to the opposite side, I heard the fatal
heart pulsating one hundred and forty in the minute, whilst the mo-
ther’s pulse was only ninety. This I pointed out to an accoucheur
present, who had previously examined her, without coming to any
satisfactory conclusion. We therefore, without hesitation, informed
her that she was pregnant; on which glad tidings I have seldom
seen more joy depicted in the countenance of any individual. This
poor woman was delivered of a healthy child about two months af-
terwards.’”
There is, obviously, a great difference in the value of the
pulsation of the foetal heart, according as positive or negative
evidence may be sought for; its presence is at once indicative
both of the existence of pregnancy, and of the life of the foetus, ,
but its absence, unless under circumstances which are fully
considered by our author, is not conclusive in the opposite way.
Compound pregnancy, complicated pregnancy, pseudo-preg-
nancy, nervous or ideal pseudo-pregnancy, and premeditated
or simulated pseudo-pregnancy, are discussed, and a mass of in-
formation and instructive cases given under each head. We
must, however, refer our readers to the work for the information
required, and we pass on to the chapter containing “ the Inqui-
ry into the Proofs of the Life and Death of the Foetus in Utero.”
This chapter is ushered in with a page or two of flourishing sym-
pathy on the “ common fate of mankind,” and a conclusion 1s
logically arrived at, that “a foetus may die at any time :” we
did not require to be told that, and where we have the long
and rugged road of science to travel, the less of the mud of
mawkish sentimentality we have to wade through, the better.
It is scarcely requisite to tell our readers how necessary it
96 Bibliographic Notices.
often is, to be able to tell confidently, whether the foetus be
alive. We cannot easily forget the delight with which a mo-
ther heard the assurance of the life of the child she carried,
after the occurrence of an accident which she feared had de-
stroyed it. Our author adduces a number of instances to shew
how necessary such knowledge is, both during pregnancy and
the progress of labour; its importance in medico-legal ques-
tions is self-evident. The usual symptoms supposed to indi-
cate the death of the foetus, whether furnished by the mother
or foetus, the true value of these symptoms and their insuffi-
ciency are shewn with a masterly hand, and the following cases
given in illustration.
“June 3rd, 1830, I was requested by Dr. Hutton to visit a young
woman named Lock, who was advanced in pregnancy, and supposed
her child dead. She had been married on the 9th of November
preceding, and had not since menstruated. She had suffered from
morning sickness, and her abdomen had been gradually enlarging,
until within the last three weeks, when it became, as she stated, flac-
cid, and something weighty was to be felt falling from side to side in
it. She had never either quickened, or felt the motions of the child ;
and now complained much of a feeling of coldness in the abdomen,
with general debility, and as she expressed it, heart sickness. Her
breasts appeared small, scarcely at all distended, and devoid of milk ;
but she stated them to have been larger and fuller until latterly.
Under these circumstances, the patient and her mother naturally
concluded the child to be dead. On applying the hand to the abdo-
men, no motion was to be felt, but the stethoscopic evidences indicated
that the child was alive, a fact which, (to the great astonishment of
the patient and her friends), was attested by the birth of a living
child, within six weeks from the period of examination. Several
similar cases could be adduced, as well as cases in which females
supposed they experienced the motions of the child, and asserted,
that it exhibited the usual evidences of its vitality, at the very mo-
ment there existed undoubted proofs of its death. A case of the
latter kind presented itself in Mrs. , who had been three
years married, during which time she had had three dead children,
with none of which she went beyond the seventh month. This she
ascribed to a venereal affection under which her husband was la~
bouring when she married him, and which he communicated to her.
She was examined by me on the first of February, 1830, when she
stated herself to be about six months and a fortnight pregnant, and
exhibited every appearance of carrying a living child: a fact which
was corroborated by the stethoscope. She was again seen by me,
in company with Dr. Whitestone, on the 12th of February, when
she still exhibited all the ordinary appearances of carrying a living
child: her breasts were full and distended, and she could press out
some milky fluid from them, her general health. and spirits were
Dr. Kennedy on Obstetric Auscultation. QF
good, the abdomen was tense and full, nor did she experience any
sensation of weight, or falling from side to side in it. She stated,
that she was confident the child was alive and well, as she had felt
its motion on that morning, These could not, however, be detected
by us, neither could the stethoscope furnish us with any evidence
of its vitality. This woman was delivered within four and twenty
hours of a dead child, the funis of which was quite putrid, and the
vessels filled with thickened black blood: the child altogether evinc-
ing evident marks of having been dead for a considerable time in the
uterus.”
Dr. Kennedy now proceeds to examine the value of aus-
cultation, in determining the life or death of the foetus in utero,
and cases are given in detail fully bearing out our author in the
value he places on it. The negative evidence of auscultation,
or the absence of the sound of the foetal heart, can only be of
value to those who are well versed in the stethoscope, and our
author warns all others to be cautious how they place reliance
on it. The caution to be observed before arriving at a conclu-
sion derived from negative evidence, the difficulties that sur-
round it are fairly put forward, and useful observations, with a
correction of an error advanced by Laennec, on the authority
of Ollivry, relative to the changes produced in the placental
souffle by the death of the foetus, appended.
‘¢ We shall now instance a few of those cases in which the foetus
was, by stethoscopic assistance, pronounced dead during pregnancy.
“ Feb. 12,1830. The wife of a coach-maker, about eight months
pregnant, called upon me, being alarmed at the supposed death of
her child. She had frequently felt its motions up to the fortnight
preceding, but not since. Experienced no other symptoms of the
child’s death. Is in perfect health, her breasts full and tense, Dr.
Whitestone assisted me in examining her with the stethoscope, and
upon repeated investigation, neither of us could detect the foetal
heart, but an abrupt and circumscribed pusaltile souffle was observ-
able low down and at the right side. This woman was delivered of
a dead, shrivelled, and putrid child, three days after our examining
her.
‘« Sept. 2, 1830. I was called to see Mrs. — in Mecklen-
burgh-street, who was suffering from deranged digestion. Sus-
pecting pregnancy in this case, the stethoscope was applied, when
a distinct foetal heart and souffle were detected, and to her great as-
tonishment I pronounced her pregnant, a circumstance that she had
not the slichtest suspicion of. She appeared to be in about the fifth
month.
‘I did not see her again until the 13th of October, when she sent
for me in consequence of a discharge of liquor amnii. About ten
days previously she had been very much alarmed from her husband
VOL. Vv. No: 13. oO
98 Bibliographic Notices.
having met with a serious accident, since which time she had been
complaining. Having placed her in bed, the stethoscope was ap-
plied, and upon the strictest scrutiny neither foetal heart nor
souffle could be detected. I, therefore, had little doubt of the
child’s death. She was delivered in the course of the night of a
foetus at about the seventh month, which exhibited all the appear-
ance of having been for some days dead. There was scarcely a drop
of blood discharged in this case, the foeto-placental circulation hav-~
ing in all likelihood been obstructed for some time before her confine-
ment.
‘* Many similar cases, observed by the author, could be here ad-
duced, but it is deemed more satisfactory to give those that have
occurred in the practice of others. Dr. W. Stokes, whose acute
stethoscopic discrimination is so well known to the professional pub-
lic, was requested to furnish the author with the result of his obser-
vation on this subject, which he was good enough to do in the fol-
lowing letter :—
“©¢50, York-street, June 29, 1835.
“<< DEAR Sir,
‘«<¢« Tn answer to your inquiries, I beg to inform you,
that, on two occasions under my observation, the cessation of the
foetal heart was followed by the birth of a dead child. Both these
cases occurred in the Meath Hospital, during the last epidemic fever,
with which disease both the mothers had been attacked, and un-
der which they were labouring at the time of delivery. I regret
much that I did not preserve accurate notes of these cases; but I
have a distinct recollection, that in both instances we heard the foetal
pulsations for several days, and in one of the patients, in a great va-
riety of positions.
*«¢ In one case, I think for two days before delivery, the sounds
could not be detected, and the woman was delivered of astill-born fo-
tus, apparently between the sixth and seventh month.
‘<¢ Tn the other case, three days before birth, I gave it as my opi-
nion that the child was dead. This was the case in which we had
heard the foetal heart in such a variety of positions. I think four days
elapsed between the cessation of the sounds and the delivery, and the
child, which was fully eight months old, was of a very dark livid co-
Jour. I have no doubt that, with due precaution, the death of the
foetus in utero can be often discovered by the use of mediate auscul-
tation.
““<T remain, dear Sir, your very obedient,
‘6S WILLIAM STOKES. ”
“<¢ To Evory Kennedy, Esq., M.D.”
Dr. Kennedy proceeds.to combat, and successfully, the opi-
nions of those who assert, that it is a matter of no consequence
Dr. Kennedy on Obstetric Ausculiation. » 99
to ascertain the life or death of the foetus during labour, the
rules to regulate practice being derived, according to them,
irom the symptoms of the mother, and in no way influenced by
the state of the foetus. In support of his views, our author
quotes Dr. Dewees’ opinion.
‘‘ Tn many instances it would be highly important to us, did we with
certainty know that the child was dead in utero. It would often
abridge the sufferings of the poor woman, and sometimes spare the
accoucheur many a deep drawn sigh, or even, perhaps, appease a dis-
turbed conscience ; but this is a matter of great difficulty, as well as
oftentimes of great moment, to decide.”
We shall not go through all our author’s arguments. It is
sufficient to convince any one of the importance of knowing
whether the foetus be alive or dead in a case of Jabour, to re-
member, that the instrument to be employed, the forceps or
crotchet, may be selected on such knowledge. ‘The presumed
usual symptoms of the death of the foetus during labour, as the
falling of the uterus from side to side, the cessation of the mo-
tions of the child, the feelings of the mother, the fetid discharge,
the evacuation of meconium, want of pulsation in the fontanelle,
or tunis, &c., are all examined in turn, and pronounced insuffi-
cient evidence : and lastly, our author comes to the examination
of the value of auscultation, as an evidence of life or death of
the foetus, and to the rules for making use of it as a test.
‘‘ For some days before labour setting in, it is a well known fact,
that the abdominal tumour descends, the uterus falling more into the
axis of the inlet to the pelvis, the head of the child resting, at the
commencement of labour, directly at the upper pelvic aperture. At
this time the action of the child’s heart is to be observed, generally,
most distinctly at the side to which the body is placed, and opposite
to that where the limbs are to be felt. It is usually somewhat lower
down than during pregnancy, and is often observed to spread com-
pletely across the lower part of the abdominal tumour, being occasion-
ally detected at the other side.
‘When labour sets in, the uterus still descending a little, the
pulsation will be lower, and heard over a more or less extensive sur-
face, as the head adapts itself to the different measurements of the
pelvis, and the foetus assumes a more or less oblique position. As
the labour advances, the pulsation is observed lower, until at length,
in some cases, it is perceptible only at a spot immediately over the
ramus of the pubis. The head now becoming engaged in the lower
strait, the face gets into the hollow of the sacrum, when the back of
the child comes gradually in contact with the parietes of the abdomen ;
and now we have the pulsation, although it may have been previously
confined entirely to one side, generally extending completely across
100 Bibliographic Notices.
the pubic, and often heard in each iliac region; where we may ob-
serve it even when the head is pressing on the perineum.
‘‘ This is the state of the case in ordinary pregnancies, where the
head presents in its most natural manner, namely, with the occiput
towards the arch of the pubis, the face being towards the sacrum.
When the face is turned towards the pubis, we observe nearly the
same phenomena. In the latter stages of labour, the pulsation extends
in a similar manner over the pubis, the breast in this case applying
itself to the abdominal parietes, as we observed the back to do in the
former case. When the face is the most depending, or asit is termed,
the presenting part, we cannot in general observe the foetal pulsation
so distinctly: at least such was the result in two cases of the kind
which we explored. This may depend a good deal on whether it is
the mento-sacral, or mento-pubic presentation. In the cases in
which we observed it, the chin of the child was towards the sacrum,
which caused the body of it to be pressed from the walls of the abdomen
against the spine, thus rendering the pulsation less distinct : whether
the same circumstance would be observed in the reverse position, is
questionable ; as in that case, the chest of the child would be pressed
against the abdominal parietes, and from the spine; thus bringing
the child’s heart into more immediate contact with the former. In
presentations of the vertex, the sound was heard much as when the
occiput presented, and generally over rather a greater extent of sur-
face: whether this arose from the position, or that the action of the
child’s heart is here more laboured, it is difficult to say.
‘From the cases of arm presentation, which have hitherto been
submitted to stethoscopic examination, we should not deem ourselves
justified in arriving at any general conclusion, as to the position in
which the feetal heart should, in such, be audible. In cases of breech
presentation, the foetal heart’s action is observed higher up, and ac-
cording to the state of advancement of labour at the time of applying
the stethoscope, above or below the umbilicus. During the progress
of pregnancy, and when the breech is resting at the superior strait of
the pelvis, the pulsation is generally perceptible above the umbilicus,
and at the right or left side according to the child’s position. Plate
III, Fig. 3, will serve to illustrate this fact. In most of the preced-
ing cases, the placenta is attached lower down in the uterus, and its
souffle is in a considerable proportion audible at one or other side, and
not unfrequently at both. We have not the heart’s action at the ra-
mus of the pubis in breech presentations, as we have in cases where
the head presents; although there is occasionally a pulsation to
be met there also. When the breech presents, with the thighs
turned towards the sacro-iliac symphisis, as is most frequently the case
the phenomenon of the fcetal pulsation is both more distinct, and more
extensive ; a circumstance which is easily explained, if we consider
for one moment, the position which the foetus then occupies, with re-
gard to the abdomen of the mother. In this position, in proportion as
the thighs and belly of the foetus approach more or less to the sacrum
Dr. Kennedy on Obstetric Ausculiation. 10k
and spine of the mother, will its back come in contactwith the ab-
dominal parietes, thus offering a substance, well calculated to conduct
the heart’s action, and in fact, bringing the heart nearer the surface
for our detection. In the position we speak of, however, the pulsa-
tion of the foetus is sometimes heard extending from two or three in-
ches above the umbilicus, over the whole of the anterior part of the
abdomen, inclining to one or the other side, according to the position
of the back of the foetus. In this way it sometimes is to be detected
so low as the pubis, and even in the right or left hypogastric region,
where we observe the heart’s action in cases of head presentation. It
is not throughout this space so distinct in its characters, as it is im-
mediately over the part corresponding to the chest of the child, which
is in general near the maternal umbilicus, marked in the figures by a
circular point. The sound heard below in these cases, may either de-
pend upon the feetal heart’s action being conducted, as we have seen
it may be, along the back of the child to the inferior part of the ab-
domen, or upon the pulsation of the umbilical cord, which may be
here situated. In foot and knee presentations, the same observations
will pretty nearly apply, with regard to the situation of the foetal
heart, as in cases where the breech is the most depending part.”
The difficulties to be encountered in stethoscopic examina-
tion during labour, cannot be easily overcome by the mere be-
ginner in its application.
‘¢We must be prepared for certain difficulties in exploring in
cases of labour, in addition to those already enumerated, as meeting
us in ordinary cases. The effect of uterine contraction is first to con-
vert the souffle into a pulsation, and eventually to suspend it altoge-
ther, whilst the contraction continues, allowing it gradually to return
whilst it subsides. The action of the uterus, also, generally prevents
our hearing the foetal heart. We can, therefore, learn nothing what-
ever, if we examine during a pain, or while the uterus is in action.
The best plan will be to commence immediately after the subsidence
of the pain, by which means we shall have the longer time to con-
duct our examination before the occurrence of the next: however,
the mid-time between the termination of the last and the commence-
ment of the subsequent pain, is the period at which we shall expe-
rience least interruption.
‘¢ The state of the bladder as to distention or contraction, will
affect the distinctness of the sounds. ‘The bladder, from pressure up-
on its neck in the progress of labour, is often prevented emptying
itself of its contents, when, the secretion of urine proceeding, this or-
ean becomes gradually more and more distended, and consequently
rises up between the uterus and parietes at the anterior part of the
abdomen, forming a tumor more or less circumscribed. This gene-
rally only renders the foctal heart less distinct, but in some cases it
actually prevents its being heard, a circumstance that indicates the
102 Bibliographic Notices.
necessity of using the catheter before pronouncing on the child’s
death.”
In this, as in all the preceding parts of the work, the views
put forward are supported by cases. We have room for only
one.
‘“* March 28th, 1829. Pegey Gallagher, tat. 34, was admitted
into hospital in labour of her third child. She had been delivered of
her first child with the crotchet, and her second had been dead born,
after a very protracted labour, from which she had a bad recovery.
On examination, the pelvis appeared contracted and small; the soft
parts were found dilated, and membranes ruptured. The head was
engaged in the pelvis, where it was locked, but the face had not as
yet got into the hollow of the sacrum. The bones of the cranium
were very much overlapped, the head seemed to have already suffer-
ed from pressure, and there was an elongated tumour upon it. It
was reported by the female in attendance on this patient before her
admission, that she had been for some days in labour, and that mat-
ters had been in their present state for the last fourteen hours. The
bladder was very much distended, and the catheter being with some
dithculty introduced, about three half pints of deeply coloured urine
were drawn off. The stethoscope was now applied, and the foetal
pulsation was discovered at the right side, beating 140 in the mi-
nute, while the placental sound was heard at a spot immediately over
the ramus of the pubis, 84 in the minute, (the rate, of course, of the
mother’s pulse). After an interval of eight hours, the head was
found to have made no advance, but there was considerable heat
of the parts. The maternal pulse and souffle had risen to 100 in
the minute. Tongue furred and dry, flushing, with much heat of
skin, and the urine, which was drawn off in small quantity, was tinged
with blood. The foetal heart distinctly perceptible, 150 in the mi-
nute. In twelve hours afterwards the head was little, if at all ad-
vanced ; a copious and extremely fetid discharge flowed from the
vagina, which was perceptible throughout the whole ward. No feetal
motion had been observed for several hours by patient. The mater-
nal pulse 120, but full. Tongue dry, with much flushing, and com-
plains of debility. On introducing the catheter no water could be
drawn off. Under all these circumstances, the probabilities of the
patient's getting well of herself were very remote indeed, whilst the
symptoms, in the opinion of many, were such as would call for imme-
diate delivery. The forceps here were out of the question, from the
size of the pelvis, (the head being as firmly bound as in a vice,) and
there had been no want whatever of uterine action. The perforator
was, then, the only alternative, and before having recourse to it, the
stethoscope was again applied by Dr. Collins and myself. The feetal
pulsation was still remarkably distinct, although increased in fre-
quency to about 160. The placental sound was also perceptible.
Under these circumstances, it was determined to allow nature to ex-
ert her energies for some time longer, watching closely the occur-
Dr. Kennedy on Obstetric Auscultation. 103
rence of any immediately urgent symptom; and in two hours, this
peor woman was, to our infinite satisfaction, naturally delivered of a
living girl, who did well. The only inconvenience attending the
delay being the slough of a portion of the integuments over the parie-
tal bone of the child, the effect of the protracted pressure.
‘‘ In this case, then, the child was, by the stethoscope, clearly
proved to be alive, although the popular symptoms of its death were
present; and the result evinced not only the correctness of this
means of diagnosis, but its practical utility in assisting us in cases
where the necessity for interference admitted of doubt.”
Dr. Kennedy strongly recommends the application of the ste-
thoscope as the most delicate test to ascertain the presence of
the action of the heart in the still-born child. We should ra-
ther trust to the naked ear as being more ready of adaptation to
the delicate thorax of the new-born infant.
We have now finished our review of Dr. Kennedy’s labour,
(we mean no pun upon the word,) and we are rejoiced that
we have deferred the conclusion of our review to this number,
for in the interval between the publication of the first part of
our review, and this the concluding portion, Dr. Kennedy’s
publication has undergone the ordeal of criticism in other coun-
tries, and has earned for its author the justly deserved and well-
merited. praise, which we had felt was his due, but which we
were chary in bestowing, lest it should be supposed that preju-
dice or partiality influenced us in favourably noticing one of the
few works brought out in our own city ; but after the warm re-
commendations bestowed on the work by distant periodicals,
we feel assured that we may now, without any imputation of
partiality or favour, say, that Dr. Kennedy has supplied a want
long felt in obstetric medicine, that he has earned the highest
praise for the industry and enthusiasm with which he has culti-
vated auscultation, as applied to Midwifery, and in short that
any one presuming to practise midwifery, without an attentive
perusal of the discoveries contained in his work, would be even
more culpable than the physician who would presume to pro-
nounce on obscure diseases of the chest, without a knowledge
of thoracic auscultation.
D.J.C.
Transactions of the Medical and Physical Society of Cal-
cutta. Vol. v1.
Tus volume evinces a degree of talent, industry, and enter-
prise on the part of our professional brethren in India, that
104 Bibliographie Notices.
places them in the foremost rank amongst the contributors to
the advancement of medical science. It contains a number of
well executed original papers and essays, the majority of which
(as might have been expected) are directed to subjects of local
interest, but there are still some, to which the attention of prac-
titioners in any clime or any nation may be advantageously di-
rected. Amongst these, one on the treatment of malignant ul-
cer and hospital gangrene: one on the ligature of the carotid
arteries: and one on lithotrity, for this operation is making its
way in India, are particularly entitled to notice.
1. Remarks on Malignant Uicer, and Hospital Gangrene,
by J. L. Geddes, Esq. Assistant Surgeon Madras Service.
In a country, the climate of which is unfavourable to the
success of surgical operations, and in which the prejudices of
the natives render it difficult, and sometimes impossible, to per-
suade them to submit to the knife, it was scarcely to be ex-
pected, that the bold measure of amputation should be resorted
to in this frightful and destructive disease with such success, as
to induce the unhappy sufferers in many instances to demand it.
Yet, this is the lesson to be learned from Mr. Geddes’ paper.
In a severe visitation of the hospital gangrene at Prince of
Wales’s Island, in 1827, amputation of the limbs was resorted
to in a number of instances, and exactly one half of the patients
saved: and the author expresses a conviction, that had he acted
in the same manner, and on the same principles, at an earlier
period than he did, several lives might have been preserved.
In civil life, the occurrence of this disease is, fortunately, very
rare; the cleanliness, regularity, and good government of our
hospitals, presenting insurmountable obstacles to its approach
or its continuance ; but in military practice the case may be far
otherwise, in consequence of long residence in one place, want
of accommodation, difficulty of procuring wholesome provisions,
crowded hospitals, or, in short, any of those numerous hard-
ships and privations to which the soldier must occasionally be
subjected. It is then to the military surgeon that these obser-
vations are more peculiarly directed.
It appears that without any ostensible cause, at least without
any cause sufficiently explained, this disease made its appear-
ance in the hospital of the 25th regiment, Madras Native In-
fantry, in the early part of the year 1827, and soon extended
rapidly and destructively. Previously there had been no case
of consequence in the hospital, most of the patients suffering
from local complaints, the greater proportion of these being itch.
Transactions of Med. and Phys. Society of Calcutta. 105
About the middle of February the malignant sore appeared, and
evinced its destructive tendency : every itch-spot and slight abra-
sion of skin, from any accidental cause, soon began to ulcerate
and degenerate into a foul phagedenic sore ; and immediately
there were about forty patients, the greater number of whom
were suffering in an aggravated degree. The sore in its first
stage appeared to be entirely confined to the skin and cellular
substance ; it spread rapidly through these textures until appa-
rently checked in its progress by the remedies employed ; and
when hopes of amendment were most sanguine, suddenly its
ravages extended much deeper, and muscle, tendon, and blood-
vessel, were rapidly invaded and destroyed. The men’s health
soon sunk under the influence of the disease. Amputation was
had recourse to in some of these latter dreadful cases, not with
any sanguine expectation of ultimate success, but with the hope
that nature might have resources and afford relief, when thus
far aided by art. Operations in this stage were performed only
as the last sad and unpleasant alternative, the patients’ full con-
sent to the measure being first previously obtained.
“The greater number of the sores, as before observed, origi-
nated from such slight causes as an itch spot, a slight excoriation of
cutis, or from an accidental scratch or bruise. In the space of
twelve hours the injured spots increased to the size of a dollar, and
gradually enlarged : two or three smaller sores coalesced, and formed
one of considerable magnitude: these were usually surrounded by a
deeply inflamed purple coloured base, very painful on being pressed,
and feeling soft and puffy on the application of the fingers: the ul-
timate extent of the ulcer usually corresponding with this circum-
scribed appearance. The ulcerativesurface varied in different subjects.
“ These were the milder forms of the complaint: when it began
to spread and assume a more malignant aspect, the ulcers presented
every variety of disorganization. The edges were ragged, elevated,
indurated, and the sore penetrated deeply into the substance of the
part affected. The inflammation extended far beyond the space ori-
ginally attacked: oedema of the feet and ankles supervened : large
sloughs were formed, and hemorrhage from the neighbouring vessels
took place in a greater or lesser degree : the discharge was excessive
and the foetor intolerable. The extent of the sores was, in many in-
stances, very great: there were two or three cases, where, from the
tuberosity of the tibia down to the ankle and over the instep, the
whole limb was denuded. One case went rapidly through its career
to a fatal termination, gangrene almost immediately taking place, and
carrying off the patient: several small abscesses that were opened by
the lancet, were converted into this formidable ulcer, one in parti-
cular, which was a common boil, on the inner part of the right arm,
spread so rapidly, as tomake me dread exposure and ulceration of the
VOL. V. No. 13. P
106 Bibliographic Notices.
humeral artery ; this accident, however, did not happen, but after a te-
dious trial of many different remedies, eranulations formed, and the
sore became more healthy. During the progress of these cases, the
men’s sufferings were intense, and the constitutional irritation ne-
cessarily great; stout, healthy men were worn down to mere ske-
letons.
‘¢ During the progressive stages of hospital gangrene, the mental
sufferings almost equal the corporeal ones; a sad and gloomy feeling
seems constantly to harass the minds of patients affected by it; there
appears no hope; there exists a perfect indifference as to their situa-
tion or fate, except as far as regards present pain; ¢he poor crea-
tures cry aloud for amputation or death.
“© | have seen no other disease (except cholera) where prostration
so rapidly supervenes.”
The circumstances that first led to the performance of ampu-
tation do not appear, unless that it was-done-as a matter of ex-
periment, and having succeeded was persevered in. The fact,
however, being established, may lead to important results, as
affording encouragement to perform the operation in other
forms of spreading and destructive disease, for there is no form
of ulceration or of gangrene, let us call it by which name we
please, more likely than this one subsequently to attack the
stump. At the same time, it may be remarked, that as a re-
medial measure it never can become very applicable to hospi-
tal gangrene, for the following as well as other reasons.
There can be little doubt of the infectious nature of this
disease ; it runs through an hospital with amazing rapidity, at-
tacking persons at the remotest parts of the ward, or even in
different wards nearly at the same time, and this too, without
any likelihood of matter being conveyed by means of towels,
sponges, &c. from one sore to another. Assuredly, in such a pesti-
lential atmosphere, no sore is more susceptible of disease, than
the surface of astump ina poor debilitated, emaciated creature, a
susceptibility acknowledged by our author in the following words :
« To obviate the danger of the stump becoming contaminated
with the prevailing affection, we must be careful, 7f possible,
to remove our patient to a purer atmosphere, to inculcate the
absolute necessity of cleanliness, and to use every precaution
that no communication take place between the convalescent and
affected ;” and as certainly if sufficient accommodation could
be procured to permit of this perfect separation, after the ope-
ration had been performed, it would be better to employ it in
preventing the necessity of resorting to it at all. The true
mode of treating hospital gangrene is, to break up the estab-
lishment in which it makes its appearance, to dismiss every pa-
tient capable of being removed, nay, more, it is often unsafe
Transactions of Med. and Phys. Society of Calcutta. 107
to admit any new patient for weeks, or even months after
every known method of purification had been employed. It is,
therefore, difficult to understand why any patient should be
brought into such a focus of infection, as would convert an itch-
spot into a malignant and gangrenous ulcer while there existed
a cot, a tent, or any kind of shelter into which he might be re-
moved, after having been subjected to a cruel disease and a
dreadful mutilation. On this point, we are furnished with no
information. Perhaps from the words “if possible,” in the
above quotation, Mr. Geddes could not always avail himself of
any means of separating the healthy from the infected, and if
so, it is easy to explain why only half the amputations were suc-
cessful. The only matter of surprize 1s, that even one re-
covered. |
Of the style and manner in which this little paper has been
drawn up, we have given‘suflicient extracts to enable the reader
to judge: of the difficulties which the writer may have had to
encounter in managing a disease so terrible in its effects, no one,
at such a distance, can be competent to form an opinion: but it
is impossible not to admire the tone of decision with which he
insists on a practice, that in his hands had been successful.
«‘ Waiting (he says) for the line of demarcation is only sealing
our patient’s death warrant, and decision in a case, as it indu-
bitably is, of life or death, must be prompt and final.” ‘There
are other affections as well as hospital gangrene, in which a de-
lay until this line of separation should be formed, has cost
many a patient his hfe.
il. Ligature of the Carotid Arteries in Epilepsy and some
other Diseases, by J. B. Preston, Esq.
Not quite thirty years have elapsed since Sir A. Cooper first
tied the carotid artery, and probably he then felt some little
fear and trepidation, lest the sudden interruption of such a cur-
rent of blood might occasion unpleasant, or even fatal results to
the delicate organ it was destined to supply. But the march of
intellect moves onwards with overwhelming rapidity, and now,
both these important vessels are taken up in the same indivi-
dual, with little mterval of time between the operations, not
only without anxiety, but in the strong expectation of diminish-
ing cerebral excitement, and removing disease. That such were
the pathological views on which these bold operations were un-
dertaken, may be gathered from the followmg passage which
we insert in the author’s words:
_ “Tf the operation should prove successful, in only a small propor-
tion of cases of epilepsy which are beyond the reach of other reme-
108 Bibliographic Notices.
dies, it will be deemed worthy of some estimation; and it might be
advisable in most of those cases, where there is evidence of predomi-
nant cerebral irritation, or of local plethora of the brain. At the
same time when we remember how often epilepsy terminates in para-
lysis, idiotey, or apoplexy, and when we observe in many of these
cases a succession of symptoms, each of which is more and more dis-
tinctly referrible to a morbid condition of the brain, and more destruc-
tive of the intellectual powers, we are induced to consider whether it
be judicious to allow even recent but very aggravated cases of epi-
lepsy to go on until irremediable organic changes are established,
without taking measures permanently and effectually to diminish the
circulation of blood through the brain.”
As in this country, it will be long before epilepsy shall be
considered so purely a surgical disease, as to be resigned at
once into the operator’s hands, the subject might be dismissed
with a single expression of admiration at the coolness and non-
chalence with which operations, here deemed so formidable, are
undertaken in India. But there is one question connected with
this subject, that cannot be allowed to pass unnoticed, although
our limits prevent its full discussion. Is epilepsy, or are the
diseases analogous to it most frequently connected with arterial
excitement, or with venous congestion? And if the latter suppo-
sition be true, will not the ligature of the carotid arteries, by
cutting off the impulse of the heart from that portion of the cir-
culation, rather tend to aggravate than to palliate the disease ?
On this point neither of the cases detailed offers any thing sa-
tisfactory; from the first nothing is to be learned, because the
patient appears to have been lost sight of a month after the se-
cond operation: from the second case we gather, that after two
years and a half of suffering, little or no material benefit had
been obtamed. An abstract of them is here subjoined.
Case 1. Headach and partial Paralysis—Francis Ful-
lingfan, a robust man, xt. 24, admitted August 10, 1831, had
been ill from the preceding April, at first with intermittent
fever, and subsequently with continued headach, for which
the usual remedies were ineffectual. Symptoms on admission,
constant pain in the head: distortion of the face to the right
side: feebleness, and inability to walk: partial loss of motion in
the left arm and leg: vision of the left eye greatly impaired:
appearance of idiotcy in expression and manner, without the
judgment being affected : alvine discharge occasionally involun-
tary: wandering at night.
After a trial of iodine, of a seton in the neck, and a blister to
the head without benefit, the right common carotid was tied on
the 2nd September. On the 7th he was free from headach,
and improved in strength. On the 27th he walked five miles
Transactions of Med. and Phys. Soicety of Calcutta. 109
which fatigued him very much: the next day he complained of
great heat in the head, and impaired vision of the left eye, his
head was shaved, and a blister applied between the shoulders.
October 3, vision not improved, although the head was quite
free: on the 6th he was ordered calomel and opium, which sali-
vated him slightly, but without relief. The left common caro-
tid was tied on the 10th, and on the 11th November he left the
hospital : vision continued imperfect, but in every other respect
he had entirely recovered his health. He was subsequently
discharged on account of the defect of vision.
Case 2, Hpilepsy and Hemiplegia. John Parcott, xt. 51,
admitted 22nd August, 1831. A short stout man: his neck
stiff and short: his head drawn down upon his chest: his eyes
full, prominent and staring: had been subject for six years to
severe epileptic fits, which came on six or seven times in the
month.—Symptoms on admission, complete loss of power of the
right side, with great impediment to utterance: the muscles of
the face drawn towards the left side: this attack of hemiplegia
occurred twenty days previously, after hard drinking. Feet
coid: great irritability of temper: the right thumb bent upon
itself, and kept down upon the palm of the hand: headach for
a long time: intellectual functions not affected. On the day
aiter admission, the right common carotid artery was tied.
The daily reports are tedious, so we shall not repeat them,
but on the 26th September, one month and four days after ad-
mission, the patient was discharged, although he had expe-
rienced seven epileptic fits since the operation. He was, how-
ever, re-admitted on the 13th November, and the other carotid
tied at once. We shall not follow the reports, but come directly
to the result; on the 25th January,—
‘“ He has had three fits since the 3rd December ; they do not render
him, even during their continuance, at all insensible. He can scarcely
speak ; and waiks with great difficulty, with the assistance of a stick.
He suffers from time to time, from a painful feeling of throbbing and
fulness in the head, which is relieved by bleeding. Although a cure
has not been accomplished in this case, owing most probably to some
serious organic lesion of the brain, still much has been accomplished.
He is able to move about with the assistance of a stick, to sit up and
enjoy the society of his family. I believe that the operations have
prolonged his life: the relief at first afforded by ligature of one ca-
rotid artery was very marked, and he is now much better than be-
fore he underwent the second operation. His life, I conceive, he
holds by a very uncertain tenure ; and that it will probably terminate
at no very remote period by the bursting of some blood vessel within
the brain.”
110 Bibliographic Notices.
January 17, 1833, (one yearand five months after the cure
was undertaken).
‘¢ About threemonths ago this man had an attack of paralysis agi-
tans, with total loss of speech, but without any impairment of the in-
tellectual functions. These symptoms entirely subsided after he had
taken iodine, with purgative medicines, for a month ; and he is now
able to walk about with one stick with ease, and speaks with very
little impediment.”
So much for tying the carotids as a cure for epilepsy! But
it is a barren field from which something cannot be gleaned, and
the mere fact of these two vessels having been tied in two dil-
ferent individuals, worn, wasted, broken down, and epileptic, is
most interesting in a physiological point of view. Within a
short space of time, the two femoral arteries of the same indi-
vidual have been tied in one of our own hospitals, (see Mr.
Collis’s paper in the present number of this Journal), and many
can recollect the objections that were raised against the at-
tempt: but when in sucha climate as India, and on the very day
of a patient’s admission, without previous preparation, and al-
most as a matter of course, such a vessel as the carotid can be
tied, and tied successfully, we are almost tempted to ask what
we have been about in Europe for so many years, and why 1s
it that we regard such an operation with a respect any higher
than Louis did that of bronchotomy, “no more troublesome or
dangerous than common venesection.” Our limits will not
permit us to notice other papers of interest in this volume.
Among them is a report of cases of lithotrity, by Dr. Cusanova,
which possesses much merit. W. HH.
A Lecture on the Functions of the Lymphatic System. By
Roserr J. Graves, M.D., M.R.1.A., King’s Professor
of the Institutes of Medicine. Hodges and Smith, Dub-
lin. Second Edition, pp. 31.
‘Tur views which are contained in this paper were brought for-
ward by Dr. Graves in the session of 1827 and 1828, a circum-
stance which we are anxious to notice, as giving to him the merit
of a priority in the development of opinions of great interest
to the physiologist, and importance to the pathologist. It is
interesting to find, that the celebrated Carus of Dresden, in
his paper on the Applications of Comparative Anatomy to Physi-
ology, has adopted the same views as those of Dr. Graves, and,
indeed, uses almost the same expressions in speaking of the
lymphatic system.
Dr. Graves’ on the Lymphatic System. lil
«It deserves particular attention, says Carus, that we meet
in the vertebrated animals, a repetition of a vascular system,
destined {o carry a simple colourless blood, (the lymphatic sys-
tem,) to whichis added another system of vessels of a still high-
er rank, and destined for the circulation of red blood: this
repetition is precisely analogous to the repetition of the gangli-
onic system of nerves in the higher classes of animals, after the
cerebro-spinal nerves have been superadded to that system.”
The views of Dr. Graves were first developed in his lectures
on physiology, in the year 1827, while the paper of Carus did
not appear until 1828, in which year it was published at Dres-
den. |
Taking as the foundation of his argument, the division of
the bodies of the vertebrated animals into red and white tissues ;
in other words, into tissues, on the one hand supplied by vessels
carrying fibrine and colouring matter, and on the other, by. ves-
sels whose blood is essentially albuminous and colourless, Dr.
Graves endeavours to shew, that in the white tissues of the red
and warm-blooded animals, such as the serous synovial, and
cellular membranes, cartilages, &c., there are vessels continuous
with the arteries, but conveying only the serous or white blood ;
and further, that these tissues are abundantly supplied with
vessels for the purpose of returning this white blood, which
vessels, according to him, are the lymphatics of former authors.
Thus in the circulation of the white parts, the lymphatics are
to the white arteries, as in the red parts, the ves are to the ar-
teries carrying red blood.
Many of our readers are aware, that several physiologists, |
and among them Rudolphi, have denied vascularity to the
white structures, holding that the exhalations of these parts are
derived from the structures in connexion with them ; in other
words, that they are transudations, just as the sweat exudes
through the epidermis: the following circumstances are, in our
author’s opinion, conclusive in disproving the above doctrine.
Ist. The appearance of red vessels in white tissues, when in a
state of irritation. That these vessels pre-existed in the tis-
sue, is proved by their sudden appearance under these circum-
stances. Now if we admit their previous existence, it follows
that the fluids circulating in them must have been white, for
otherwise they would have been visible.
2ndly.. The inflammatory vascularity of parts unconnected
with any red tissue, as for imstance the pseudo-membranes
formed between the pleura pulmonalis and costalis, and also the
synovial membrane; which is super-imposed on other white
tissues—the cartilage and. capsular: ligament.
112 Bibliographic Notices.
‘These are the principal arguments: others are deduced from
the similarity in composition of the cellular and serous exha-
lations with the serum of the blood ; and also from the experi-
ments of Mayer, who injected solutions of prussiate of potash
into the lungs of animals, and in a few hours was able to detect
its presence in many of the white tissues. We may remark,
however, that the result of this experiment may be in some de-
gree explained by the singular permeability of the living tissue
to certain fluids, as demonstrated by Dutrochet and Mitchell.
In support of the opinion, that the lymphatics are the veins
of the white parts, the following analogies between them and
veins commonly so called, may be referred to: Ist, the provi-
sion of both with valves; 2nd, the equable current of fluid in
both towards the heart ; 3rd, the contents of both being
subjected tothe process of aeration, and hence the reason of that
portion of the fluid, which had not joined the red veins before,
bemg emptied into them, previous to their arrival at the heart.
Fohman has described a large lymphatic trunk conveying lymph
to be aerated in the gills of fish, while another trunk conveys
venous blood to be aerated in the same organ.
“This fact, says Dr. Graves, evidently accords as much with the
idea of the lymphatics conveying back white blood to be renewed
by respiration, and rendered again fit for the nutrition of the white
parts, as it is irreconcileable with the commonly received opinion, of
their containing the useless debris absorbed from the various organs.
‘“Many objections, indeed, of great weight, have been urged
against the opinion, that the lymphatics convey back the debris of
all parts of the body, or in other words, serve the purpose of removing
by absorption, all that has become useless in the different structures.
The fluid they contain is too colourless to be the vehicle of coloured
particles, and is too simple and uniform in its composition, to allow
us to Suppose it to be formed by the union of particles absorbed from
structures so various as those of the body. .
‘“ That the lymphatics perform the office of returning the white
blood, (by white blood I mean not a fluid absolutely colourless, but a
fluid destitute of the peculiar colour of red blood,) is further rendered
probable by the fact, that when in disease red blood finds its way
into the white capillary arteries of white parts, the lymphatics are found
to carry red blood from the inflamed part, and in suppuration, puru-
lent matter has been also found in the lymphatics.”
The fact just mentioned, of the lymphatics carrying red
blood was, we believe, first noticed by the celebrated Mascag-
mi in cases both of pulmonary and abdominal hemorrhage.
Among others, Dr. Graves quotes Cruikshank, as describing
the same phenomenon. From these facts we should expect,
Dr. Graves’ on the Lymphatic System. 113
that, in cases of suppuration, the lymphatics would contain pu-
rulent matter; and that such is the fact we have no doubt,
though Magendie, in relating a case observed by Dupuytren,
and reported by Cruvelhier, attempts to show that the fluid
in the lymphatics coming from the suppurated part, was in
reality not pus.
On this subject Dr. Graves is fortunate in being able to quote
a most convincing case (of fatal psoas abscess) which occurred
under his own care, the particulars of which are published in
the fifth volume of the Dublin Hospital Reports ; from which
we shall quote the following account of the post mortem appear-
ances.—“ The abscess contained a large quantity of healthy
pus. ‘The internal surface was quite smooth, as if it had been
lined with serous membrane, and exhibited, towards its infero-
posterior portion five or six orifices of the diameter of peas,
funnel-shaped, and having their surfaces perfectly continuous
with that of the sac. They terminated in organized tubes,
which appeared to be lymphatics, for they led to a mass of dis-
eased glands that lay on the brim of the pelvis. Having care-
fully separated the sac, the lymphatic glands, and the thoracic
duct, we found the vessels between the glands and the abscess
filled with pus, precisely similar to that of the abscess, while the
glands were distended with matter evidently of a similar origin,
but changed in its physical properties. In some it was still
fluid, but much thicker than in the abscess; in most it was
converted into a soft cheesy mass. From these glands ascend-
ed a chain of lymphatics, communicating with the thoracic duct,
and containing solid matter resembling that of tubercles. The
thoracic duct was distended to the size of the middle finger,
and felt hard and nodulated. It was found to contain a similar
matter, but much harder in consistence, and mixed with a large
proportion of a calcareous substance, such as occurs in diseased
bronchial glands, &c.”
This case must be considered as decisive ofthe point. We
believe that the appearances observed in this instance are per-
fectly analogous with what are seen in certain cases of acute and
chronic ulcerations of the small intestines. In the first variety
we may find the lymphatics proceeding from each patch of ulce-
ration, full of reddish purulent fluid, and the gland in which
they terminate containmg a quantity of the same. This we
have observed in cases of bad gastro-enteric fevers. On the
other hand, in chronic ulcerations, nothing is so common as that
the situation of the ulcer shall be pointed out by the appear-
ances of the congeries of lymphatiés, as seen through the perito-
neum ; gorged, white, and containing a semi-fluid matter, which is
VOL. V. NO. 13. Q
114 Bibliographic Notices.
to be deposited in the mesenteric glands. And we would con-
sider those depositions of purulent matter im the viscera, which
have been described by Velpeau, Andral, Carswell, and many
others, as occurring without previous inflammation of the part,
quite analogous to the state of the lymphatic ganglia, in cases
of purulent absorption. The lung, liver, spleen, and thymus,
may be to the veins what the ganglia are to the lymphatics.
The viscera on the one hand, and the ganglia on the other, act
in purifying the fluid which traverses them ; partly by a process
of addition, and partly by one of separation. Fohman’s con-
jecture that the lymphatic glands serve to aerate the lymph, is
strengthened by the fact, that the sac-like appendages of the
venous system in white tissued animals, dimimish in number
and size as we ascend in the scale ; in other words, as the lym-
phatic ganglia become more developed.
The analogies between lymphatics and veins may be further
illustrated by the fact, that both contain fluids with properties
notunlike ; fluids separable into a crassamentum and watery por-
tion, and capable of receiving an important change from the ac-
tion of air. Finally, the intimate connexion and anastomoses of
the minute lymphatics with veins, has been demonstrated by
Meckel, and described by him in his splendid work, dedicated
to Soemmering.
We shall conclude this notice by the following important
extracts, and in particular call the attention of our readers to
the analogy drawn between the reproductive powers of parts
in the lower animals, and the same phenomenon in the white
tissues of the higher.
‘‘ The nutrition of the red parts is accomplished by the constant
circulation of red blood through them, that of the white parts, by the
circulation of the serous portion of the blood; and to effect these
two different purposes, a portion of the serum is separated in the
smaller vessels. When, however, the red blood and the white blood
have circulated through the red and the white parts, there is no longer
any necessity for their being kept altogether distinct from each other ;
in the mammalia the conglobate glands, in the first instance, serve
to promote the reunion of the red and white blood, and the larger
lymphatics, which open into the subclavian veins, finally complete
the reunion of these two portions of the blood. In fishes, Fohman
has pointed out numberless communications between the venous and
lymphatic system, almost at the roots of the latter.
‘¢ The white structures of the higher animals, resemble the solids
of white-blooded animals, not only in health, but disease. Thus the
power of reproduction of parts destroyed by accident or disease, so
remarkable in the lower orders of animals, is in the higher enjoyed
only by white structures, such as cellular membrane, for proper mus-
cular fibre when once destroyed is not reproduced, condensed cellular
Dr. Graves’ on the Lymphatic System. 115
membrane being employed to repair solutions of continuity, in this
as well as all more highly organized tissues.
‘‘ In white-blooded animals, we often see a new limb appear in
the place of one destroyed by accident, and in man it is not unfre-
quent to observe a new white organ produced when the old has be-
come useless, or been destroyed. Thus in unreduced dislocations, we
have new bursee mucose, capsular ligaments, synovial membranes,
&c. produced so as to form almost all the appendages necessary either
to the strength or motion of the new joint. The same happens in
ununited fractures. Cartilage is thrown out to supply the place of bone
removed by operation or disease, and under favourable circmstances,
this cartilage itself becomes ossified, and, as happens in Necrosis, an
entirely new bone is sometimes produced. In all such cases, the
mould of the bone, or that part of it to which the new bone owes its
form and bulk, is composed of a white structure, chiefly coagulated
albumen: this is first formed, and afterwards the bony particles are
deposited in it from red vessels.
“This facility of reparation forms a very striking analogy between
the white parts in man and other red-blooded animals, and the general
structure of the solids in white-blooded animals. In point of vitality,
the analogy is most striking. The white parts in man, when not in-
flamed, (then they for a time become red parts, and have a corres-
ponding increase of vital energy,) enjoy but a low vitality. They
are scarcely, if at all, sensible ; do not possess irritability ; and pro-
bably, also, the circulation of the white blood through them is much
slower than that of the red blood through the red parts; at least the
circulation of the white venous blood in the lymphatics appears much
less rapid than that of the red venous blood in the veins.” —Page 19.
‘‘The view already taken of the intimate connexion in all the dif-
ferent classes of animals, between the development of the white parts
and that of the lymphatic system, is easily explained on the supposi-
tion of the lymphatics being the veins of the white parts. In inver-
tebrated animals which have no red blood, it would be more rational
to call the vessels conveying the white blood back to the heart, lym-
phatics, than veins: for it is more consistent with analogy to sup-
pose, that in the lower animals, the retained portion of the circulat-
ing system corresponds with the former, as in the superior animals
the lymphatics are connected with parts, which, in their degree of
vitality, most resemble the structures of the lower animals.
‘In the higher classes of animals, there are not only two circn-
lating systems, one of red blood, and another of white blood, but also
a two-fold system of nerves, the cerebral and the ganglionic ; the
latter of which, in invertebrated animals, seems to perform all the ner-
vous functions necessary to their state of existence; while these
animals are also remarkable for possessing only a simple vascular
system,
‘‘ We find, therefore, a correspondence between the vascular sys-
tem of red blood, and the nervous system of the brain and spinal
marrow. They are most perfect in animals most abounding in high-
116 Bibliographic Notices.
ly aerated red blood, and decrease according to the descending scale
‘proportioned to the decrease of red blood, until at last we arrive at
the invertebrated animals, possessing no red blood, and no brain or
spinal marrow.”’—Page 24.
We trust that Dr. Graves will still further elucidate the facts
and opinions contained in this paper ; facts and opinions which,
we scruple not to say, contain the germs of explanation of many
points in the anatomy of formation, and in the higher parts of
pathology; particularly those referring to the scrofulous diathesis
WS.
and other arrests of development. *s
Principles of Geology. By Cnartes LyzLt.
(Continued from Vol. LT. page 417.)
ResuminG our observations on this important work, we shall en-
deavour to give our readers a still clearer perception of its value
and excellence, by placing before them in the strongest hght
the principles it mculcates, and we are the more induced so to
do because there is no habit, whether in moral or physical sci-
ence, more common than that of looking at the objects before
us, just as if they had never passed under the modifying influ-
ences of long-continued circumstances or forces. In moral sci-
ence this habit is replete with evil, as it leads to erroneous rea-
sonings founded on the supposition of originality in the condi-
tion of certain characters and propensities, which have in truth
been forced into an unnatural development by artificial train-
ing; and in physical science it has equally operated against the
true understanding of the laws of nature, by diverting the ob-
server from an inquiry into the various states through which
each object, susceptible of change, must in the course of ages
have passed. Geology has perhaps more than any other science
suffered from this habit, for in the production ofall its visible results,
time has been so overpowering, so essential an element, that it was
often found or thought impossible to connect the ultimate with
the primitive condition of the object observed; for instance, to
see the materials of the sandstone and conglomerate rocks, now
elevated into extensive mountain chains, hurrying along under
the influence of tidal or other currents, and depositing as sand
or shingle banks at the bottom of the ocean ; to trace in the
long ranges of limestone rocks, full of organic remains, the ves-
tiges of ancient lakes or estuaries ; to follow back the successive
steps of increment, by which the present valley, wide and deep
as it now is, may be proved to have commenced in a shallow
Lyell’s Principles of Geology. 117
and minute ravine, the bed of a stream, the ceaseless action of
which has produced so vast an excavation that its waters are
lost in the very depth of its own works, or to see in the granitic
mountain and the basaltic peak or ridge, melted matter either
simply projected upwards, and cooling into domes and pinna-
cles, or flowing in streams from the submarine crater, condensed
and restrained by the pressure of asuperincumbent ocean. Yet
to read rightly the records of past ages, and to connect them
with the history of the present, it is essentially necessary to free
our minds from the prejudices of habit, and to adopt a course
of inductive reasoning which will enable us to discover analo-
gies, where we should at first sight discern only dissimilarity
and discordance. The great object of the work before us is, to
effect in geology this desirable end, and we may fairly say, that
our author has to a great extent, if not entirely, attained his
purpose. In our preceding remarks we entered with him on
the question of the igneous origin of granite, for to the early
geologists the highly crystalline arrangement of its component
parts proved a serious stumbling block, since they deemed it
only reconcileable with deposition from some solvent menstruum,
being thereby obliged to call into being fluids different in their
chemical properties from any now known to us. The experi-
ments of Hall and Watt have, however, removed these difficul-
ties, and the careful examination of granite and porphyritic
dikes, has left no room for doubt as to the igneous origin of the
great masses of rock from which they have emanated.
‘Granite, porphyry, and other rocks of the same family, often
occur in large amorphous masses, from which small veins and dikes
are sent off, which traverse the stratified rocks called primary, pre-
cisely in the manner in which lava is seen to penetrate the secondary
strata. We find also one set of granite veins intersecting another,
and granitiform porphyries intruding themselves into granite, in a
manner analogous to that of the volcanic dikes of tna and Vesuvius,
where they cut and shift each other, or pass through alternating beds
of lava and tuff.”—Page 353.
And this statement our author supports by several instrue-
tive and illustrative drawings, principally taken from the works
of M‘Culloch.
The more, indeed, we contemplate these phenomena, and the
wider the range of characters we take into consideration, the
more firmly shall we believe in the identity (as to mode of for-
mation) of plutonic and volcanic rocks. Prismatic structure,
vems and dikes, disturbance and distortion of the intersected
strata, and sensible alteration of the substances in contact with
them, are alike common in both classes of rocks. The re-
markable dikes of the Val del Bove, projecting like huge ver-
118 _ Bibliographic Notices.
tical walls from the flanks of AZtna, are good examples of the
first step of the analogical series beginning in the products of
still active volcanoes, and after passing through-the more an-
cient basalts and greenstones terminating in granite.
‘¢ Some of these are composed of trachyte, others of compact blue
basalt with olivine. They vary in breadth from two to twenty feet
and upwards, and usually project from the face of the cliffs. They
consist of harder materials than the strata which they traverse, and,
therefore, waste away less rapidly under the influence of that repeated
congelation and thawing, to which the rocks in this zone of A!tna are
exposed. The dikes are for the most part vertical, but sometimes
they run in a tortuous course through the tuffs and breccias.” —Page
90.
Approximating, therefore, in one case to ordinary trap
dikes, and in the other to veins; or if we turn to the other end
of the series, we find, that,
‘‘ In the plutonic as in the volcanic rocks there is every gradation
from a tortuous vein, to the most regular form of a dike, such as those
described as intersecting the tufis and lavas of Vesuvius and A‘tna.
In the dikes of granite which may be seen, among other places, on
the southern flank of Mount Battoch, one of. the Grampians, the oppo-
site walls sometimes preserve an exact parallelism for a considerable
distance.” —Page 357.
So that whatever part of the series we examine in this par-
ticular, the analogy is complete. In like manner examples of
change of structure, produced by the intrusion of igneous rocks
amongst, and their contact with sandstones and limestones, may
be taken either from volcanic, from trap, or from plutonic rocks,
as in the Cornish granites, where “changes are sometimes
caused in the intersecting strata, very analogous to those which
the contact of a fused mass might be supposed to produce ;’?—
page 355; in Glen Tilt, where the limestone is so affected by
its approximation to the granite, that “ the crystalline texture
disappears, and it assumes an appearance exactly resembling
that of hornstone; the associated argillaceous schist also often
passing into horn-blende slate;” and in the department of
the Hautes Alpes, in France, near Vizille, where M. Elie de
Beaumont traced a black argillaceous limestone charged with
belemnites, to within a few yards of a mass of granite.
‘‘Here the limestone begins to put on a granular texture, but
is extremely fine grained. When nearer the junction it becomes
grey, and has a saccharoid structure; and in another locality near
Champoleon, a granite, composed of quartz, black mica, and rose-
coloured felspar, is observed partly to overlie the secondary rocks,
producing an alteration which extends for about thirty feet down-
Lyell’s Principles of Geology. 119
wards, diminishing in the inferior beds which lie farthest from
the granite. In the altered mass the argillaceous beds are hardened,
the limestone is saccharoid, the grits quartzose, and in the midst of
them is a thin layer of an imperfect granite. It is also an important
circumstance, that near the point of contact both the granite and the
secondary rocks became metalliferous, and contain nests and small
veins of blende, galena, iron, and copper pyrites.”— Page 371.
When then we see these analogies in the more striking of
their phenomena, and find also a gradation between trap rocks
and granites, effected by the addition or subtraction of some of
the usual component minerals, we are prepared with our author
to admit, that
“It would be easy to multiply examples to prove that the grani-
tic and trap rocks pass into each other, and are merely different forms
which the same elements have assumed, according to the different
circumstances under which they have consolidated from a state of
fusion.”-—Page 362.
But arrived at this important conclusion, we have yet to in-
quire, whether the varying forms of igneous rocks have resulted
from a variation of the forces, which have impelled them suc-
cessively to the surface, giving rise at remote periods to gra-
nites, then to traps, and last of all to recent lavas; and the in-
quiry leads us to one of the most interesting of modern geolo-
gical investigations, the age of granites. It is here, perhaps,
scarcely necessary to remind the reader, that the term primi-
tive applied to this rock, and to gneiss, mica slate, &c., had its
origin in the theory of their prior formation, and consequently,
that they were supposed to underlie all other rocks. But in
this as in most of the early applications of philosophical rea-
sonings to practical science, generalization commenced before
a solid foundation for it had been laid in the accumulation of
facts, and as a consequence, more extended observations have
overthrown many such hasty deductions, or at least modified
greatly their import. That granite as a mass, or indeed any
other igneous rock, should be found under those strata which
have been formed out of the shattered and rolled fragments of
pre-existing rocks, or by the accumulated relics of successive
races of organized beings, is a necessary consequence of its
mode of formation, for within the crust of the earth could alone
be found an adequate source of heat, to produce the required
fusion. But the time of appearance on the surface is distinct
from that of original position or formation, and here it is that
modern discovery has thrown a new light on the subject, and
proved by the study of granite and porphyritic veins, both in
120 Bibliographic Notices.
their passage through and the disturbance they effect on
stratified deposits ; and also, by a close examination of the
changes from conformability to unconformability m the strata
of mountain ranges, that the epochs of eruption of granite have
been as numerous, and as widely different in point of age, as
those of trap or even of volcanic lavas. ‘The instance we have
already adduced of a granite near Champoleon, which in part
overlies oolitic strata, is sufficient to illustrate this important
truth, but it will be well also to quote the words of Brongniart,
Tableau des Terrains, page 329, as propounding it in the most
distinct manner :—“ ‘These results of observations, at once va-
ried and intricate, although singly received with caution, ac-
quire, when combined together, such force, as to induce an ad-
mission, that the plutonic granite (particularly that with a por-
phyritic structure) has appeared at several distinct epochs on
the surface of the earth, covering each time some portion of the
strata which then formed the exterior surface of the globe.”
Brongniart mentions three such epochs, viz. after the deposi-
tion of the transition strata, after that of the coal formation, and
between the new red sandstone and the inferior oolite. We
shall add also, from a report of Humbolt’s recent Travels in
Asiatic Russia, an example which, from its magnitude, deserves
especial attention :—Annales des Sciences Naturelles, vol. xxiv.
p- 228. “ In returning from Khoni-Mailakhon to Ust Ka-
menogorsk, the travellers traced for more than 5000 metres
along the secluded banks of Boukhtarma, granite divided into
almost horizontal beds, and spread over a slate, the strata of
which are in part inclined at an angle of 85° in part horizon-
tal.”—No longer then is it mere conjecture, but a fact estab-
lished on the clearest evidence, that “ some granites and egra-
nitic schists are of origin posterior to many secondary rocks,”
p- 374. In other words, “ some primary formations can al-
ready be shewn, to be newer than many secondary groups,
a manifest (as our author further observes) contradiction in
terms ;” to remove which he proposes the word “ hypogene,”
or nether-formed, as a substitute for primitive or primary.
Having thus satisfied ourselves’that granites, like trap rocks,
have been brought to the surface of the earth at several diffe-
rent epochs, and contemplating the great extent of that surface
they occupy, and the connexion which the eruption of such
large masses must have had with its configuration, we are led
from the rock to the mountain, from a consideration of the age
of the mineral mass to that of the mountain chain. Not indeed
that we are to expect to find each instance of elevation accom-
panied by a visible development of igneous rocks, any more
Lyell’s Principles of Geology. 121
than we find each shock of an earthquake accompanied by vol-
canic eruption. ‘That such rocks should be poured out requires
a rupture of the earth’s crust, and it may so happen, that as in
the phenomena of recent earthquakes and volcanoes, the shock
and elevation of the surface may have taken place at a distance
from the spot, where through less cohesive materials, the strug-
gling and semi-fluid mass was enabled to force a passage. In
this way we may understand, how in some cases the elevation
has affected a great extent of surface, giving rise to high table
lands, in others being limited in breadth, has produced a
greater amount of rise in mountain chains. In some has rent,
torn, and twisted the strata, without the appearance of melted
matter, whilst by veins and dikes, its proximity to the site of
disturbance has, in others, been rendered apparent. To Mr.
Elie de Beaumont is due the merit of attempting to collect
together the facts bearing on this truly interesting branch of
geological science, and to “ reduce them to one systematic
whole.” In his memoir read before the French Academy, and
subsequently published in the Annales des Sciences Naturelles,
he details the results of his inquiries, and establishes, by a con-
sideration of the particular part of the series of strata in each
chain, where conformability between the successive layers has
ceased, ten distinct revolutions or epochs of elevation. Subse-
quently, as stated by M. De la Beche, he has distinguished
twelve such epochs, it being a main principle of his theory,
that the operation of the force producing each elevation, has
extended to all those mountain chains, in which the breach of
continuity in the strata appears, at the same points of the geo-.
logical scale, and further, that ‘a parallelism exists in the di-
rection of the several lines of every distinct and contemporaneous
elevation. As this theory is based on the hypothesis of revolu-
tions so sudden and violent, as to give rise at a single effort to
great mountain chains, the moving force acting with fearful in-
tensity after long intervals of repose, it differs essentially from
that of our author, in which is advocated a frequent repetition
of moderate efforts, corresponding with observed facts, and con-
nected with “ the intermittent action of subterranean volcanic
heat, as a known cause capable of giving rise to the elevation
and subsidence of the earth’s crust, without interruption to the
general repose of its habitable surface,” p. 339. M. Elie de
Beaumont does indeed, like our author, suppose that the causes
which once acted may act again, for, Annales des Sciences Nat.
tom. xix. p. 233, referring to the results of his memoir, he ob-
serves, “ it is difficult to foresee such a modification as would
lead us to suppose, that the mineral crust of the terrestrial
VOL. V. No. 13. R
122 Bibliographic Notices.
ae has lost the property of being wrinkled up in various
irections, and that the period of tranquillity in which we now
live will not again be disturbed by the appearance of a new
system of mountains, resulting from a new dislocation of the
surface of the earth, the foundations of which are yet, as earth-
quakes sufficiently warn us, capable of being shaken.” But
in substituting “ paroxysmal violence for the reiterated recur-
rence of minor convulsions, and in ascribing the instantaneous
rise of mountain chains to the secular refrigeration of the in-
ternal nucleus of the earth, he widely departs from our author
both in seeking new causes, and in attributing to others a kind
and a degree of action, not in accordance with the visible ef-
fects of these which are yet in operation. In the 24th chapter,
our author discusses this question of difference at length, ad-
ducing the arguments of Boué and others against the correct-
ness of some of M. Beaumont’s facts, and the serious objection
taken to the doctrine of parallelism as an evidence of contem-
poraniety, from M. Beaumont’s important admission, that “ the
elevating forces, whose actions must be referred to different
epochs, have sometimes acted in Europe in parallel lines,”
p. 346; asking, “ on what principle then is the age of an
Indian or trans-Atlantic chain referred to one of these EKuro-
pean lines rather than another?” p. 347. Professor Sedge-
wick has, indeed, declared his adhesion to the opinions of M.
Beaumont, although he has remarked, “ that i consequence
of the spheroidal figure of the earth, different mountain chains,
running north and south, cannot be strictly said to be parallel,
since they would, if prolonged, cross each other at the poles.”
page 347. And M. Conybeare “ points out many lines of
distinct ages in England, which are exactly parallel, and others
which, according to the rules laid down by M. de Beaumont,
ought to agree m age with certain continental chains, and yet
do not, having an entirely different direction,” p. 348. He im-
agines also, “ that the general strike of the secondary strata of
our island, from N. E. to S. W. has been the result not of any
violent or single convulsion, but on the contrary, of a gradual,
gentle, and protracted upheaving, continued without imterrup-
tion during the whole period of the formation of all these
strata,” and in like manner that in mountain chains, their rise
is attributed with greater reason to a series of shocks occurring
at intervals, “ through a long period of ages,” than to one
blow, since “ such an hypothesis is most conformable to the
only analogy presented by actual causes, “ the operation of
volcanic forces.” We shall not dwell further on the question
of parallelism in contemporaneous mountain chains, because to
Lyell’s Principles of Geology. 123
us it appears evident, that any force of the volcanic kind, suf-
ficient to thrust up at one effort the mountain ranges of diffe-
rent and distant countries, must (to obtain the power of pro-
ducing such an effect) have been so deeply seated in the inte-
rior of the globe, that its action would necessarily have pro-
ceeded from a centre, and been manifested on the surface in
lines corresponding with, or at least approximating to great
circles of the sphere ; and adopting the theory of refrigeration
of the external crust, accompanied by its contraction and a
consequent pressure on the internal melted mass, when the
crust had been, by the resistance of that nucleus to its further
contraction, fractured, (just as a glass might be by the unequal
contraction of its external and internal coats,) and the melted
matter forced by pressure through the opening, a theory which
weare far from thinking mysterious, we should still expect to find
the cracks, if regular, corresponding to circles of the sphere ;
though doubtless, they would in nature be irregular from the
various modifications dependent on unequal cooling in different
parts. But even should we reject the doctrine of parallelism,
the question of instantaneous rise would not be affected by that
determination, and as yet we think the data afforded by actual
observations insufficient to decide it. Our author’s arguments
shake indeed M. de Beaumont’s conclusions, but to overthrow
them entirely, it is necessary to examine minutely the appear-
ances of the elevated and disturbed strata, and to connect them
with an efficient cause, in other words to coordinate cause and
effect. And we enforce this, because the occasional manifes-
tation of extraordinary energies arising out of accumulated
forces appearing as consistent with the analogies of nature as
an extraordinary tide, a hurricane, or an unusually tremendous
earthquake may be, we should expect to discover, in the dis-
turbance of strata, evidences both of moderate and of excessive
violence. This class of inquiry has now been entered upon,
and in the work of M. Thurmann, on the “ Soulévemens Ju-
rassiques du Porrentruy,” we find the several phenomena of
disturbance classified, according to the several kinds or forms
of elevation, and the various accidents which effected them.
Of the ultimate bearing of this work, (a small portion of it only
having as yet appeared,) on the question at issue, it is difficult
to predicate: in the part before us, the author speaks indeed
of the gigantic elevations of the Jura, but we imagine with re-
ference to the aggregate result, since he observes: “ it is only
after having studied the whole of the vast system of the Jura,
that we shall be able to form a correct idea of each of the
partial elevations which have contributed to its production,”
TA Bibliographic Notices.
p. 69. It seems indeed impossible to contemplate the general
surface of the globe, raised as it has all been from the bosom
of the ocean, without perceiving, that the mountain chain must
at one time have participated in the elevation of the plain, at
another been detached from and raised above it by the con-
ceniration of the uplifting force within a narrow compass; and
the more we succeed in discerning distinct lines of direction,
however partial, in the phenomena of disturbance, the more
reason we shall have to suppose, that the great resulting ele-
vation has proceeded from a combination of minor and _ suc-
cessive elevations. Jn short if we hesitate to admit the instan-
taneous elevation of a continent, why should we advocate that
of one, nay, of many mountain chains? Enough, therefore, we
think, has now been said, to satisfy our readers that in this por-
tion of our subject, our author has demonstrated, to a certain
extent, a similarity and consistency in the operations of nature
(both in kind and degree) at all times, for we have seen that
granites and other igneous rocks have been poured out at va-
rious epochs, assuming this or that character, according to at-
tending circumstances, and can therefore readily admit that at
this moment, under the pressure of a superincumbent ocean, they
may still be formed and ejected; and in like manner when we
have traced with him the numerous stages through which our
continents and mountains have passed towards their present
elevation, we cannot doubt, that other rocky masses are on
their way from the deep recesses of the sea, to form hereafter
new continents and new mountains, when those now in being
have been gradually worn away, or sapped at their base by
the long-continued action of subterranean forces, have again
sunk to the depths whence they came. Turning from igneous
rocks, and the phenomena which have attended their produc-
tion and elevation at various epochs, to the surface of the earth,
we have now to consider, whether a similar degree of analogy
can be discovered between the ancient primary strata, and more
recent sedimentary and stratified deposits; and further, how
far such formations generally can be shewn to accord with
the productions of existing and still acting causes. In some of
our preceding remarks, we have already placed the sandstones
and conglomerates in juxta-position with sand and _ shingle
banks, now formed or forming along our shores, and to sup-
port the analogy, we may appeal to examples amongst the se-
condary strata, on one hand, of masses of sand scarcely con-
solidated into stone, and on the other to the shores of the
Mediterranean, or even of the channel, (as at Kingstown,)
of sand and shingle, either actually consolidated or in course
Lyell’s Principles of Geology. 125
of being so. But can we in like manner find amongst recent
productions, a type for such rocks as the primary schists.
eneiss, mica-slate, clay slate, or even for those extended fields
of limestone which abound in this island? ‘At first sight it
would appear impossible to do so, for where should we seek a
modern formation, any part of which could be compared with
gneiss,—a compound rock at once crystalline and stratified, re-
sembling granite so closely in structure, that im hand speci-
mens it 1s often undistinguishable from it, and at the same time
approximating in stratified arrangement to the sedimentary de-
posits. But in this as in every geological investigation, we
must keep in view the fact, that the surface of the earth, as we
now see it, exhibits not one class only of phenomena, but an
assemblage of many, and draw from it a caution not to con-
found together those which in their nature are distinct: to
compare for instance, the modern sedimentary deposits, con-
solidating at a small depth below the surface of the sea or of
lakes, by the infiltration and absorption of mineral matter, with
rocks which have been formed at the lowest depths of the ocean,
under the combined influence of enormous pressure and of in-
tense heat. To institute then a comparison with gneiss and
other stratified primary rocks, we should have to restore the
circumstances under which they were produced, to refer to
strata forming under a similar pressure and in proximity to a
similar source of heat, and to operations veiled from us by the
ocean which is an element essential to their development. It
is on this principle that our author details the marked analo-
gies between primary and other formations, which are displayed
in their mode of stratification, particularly in the alternation in
each of beds, varying greatly in composition, colour, and
thickness. , :
‘‘ In the secondary and tertiary strata of pure siliceous sand, al-
ternating with micaceous sand and with layers of clay, as in the pri-
mary beds of pure quartz, with mica schist and clay slate. In the
secondary and tertiary series, limestone alternating again and again
with micaceous or argillaceous sand, just as in the primary, gneiss and
mica schist alternate with pure and impure granular limestones :”—
page 366.
And adopts the theory of Hutton, as that which reconciles
best these features of agreement, with the strong marks of
distinction found in the highly crystalline and granitic strue-
ture of primary rocks.
“Tf, says he, reasoning from the principle that like effects have
like causes we attribute the stratification of gneiss, mica-schist, and
other associated rocks, to sedimentary deposition from a fluid, we en-
126 Bibliographic Notices. —
counter this difficulty, that there is often a transition from gneiss,
one of the stratified series, into granite, which, as we have shewn, is
of igneous origin. Gneiss is composed of the same ingredients as
granite, and the texture is equally crystalline. It sometimes occurs
in thick beds, and in these the rock is often quite undistinguishable
in hand specimens from granite; yet the lines of stratification are
still evident. These lines imply deposition from water, while the
passage into granite would lead us to infer an igneous origin. In
what manner can we reconcile these apparently conflicting views ?
The Huttonian hypothesis offers, we think, the only satisfactory so-
lution of this problem. According to that theory, the materials of
gneiss were originally deposited from water in the usual form of
aqueous strata, but these strata were subsequently altered by their
proximity to granite, and to other plutonic masses in a state of fu-
sion, until they assumed a granitiform texture.” —Page 367.
Our author quotes several examples of alterations in tex-
ture, by the contact of trap and volcanic rocks with sedimentary
deposits, as illustrative of this change, and having referred also
to the “ direct experiments on the fusion of rocks in the labora-
tory,” proposes the term “ metamorphic” for stratified primary
rocks, as a designation involving no chronological import, and
pointing to the change which is presumed to have taken place.
This theory is indeed supported by many remarkable facts ; for
instance,—
‘<In parts of Germany, also, there are schists which, from their
chemical condition, are identical with hypogene schists (7d es¢ pri-
mary schists), yet are interstratified with greywacke, a rock probably
modified by heat, but which contains casts of shells, and often dis-
plays unequivocal marks of being an aggregate of fragments of pre-
existing rocks.—Page 376.
And if true, there may have been many formations of such
rocks going on at various and distant periods. But reasonable
as it in many respects is, some difficulties do yet beset it. For
example, when our author says,
‘¢ A considerable difficulty and misapprehension, in regard to the
antiquity of the metamorphic rocks, may arise from the circumstance
of their having been deposited at one period, and having assumed
their crystalline texture at another. Thus, for example, if an eo-
cene granite should invade the lias, and superinduce a hypogene
structure, to what period shall we refer the altered strata? Shall we
say, that they are metamorphic rocks of the eocene or liassic eras ?
They assumed their stratified form when the animals and plants of the
lias flourished ; they became metamorphic during the eocene pe-
riod ;”—Page 378. |
Lyell’s Principles of Geology. 127
we must at once see that the circumstances detailed are ra-
ther those which attend the intrusion and passage of basaltic
dikes, than those which have been premised as indispensable
to the production of gneiss, mica slate, and other stratified
primary rocks. Neither the pressure attendant on great
depth, nor the long-continued heat arising from contact with a
great mass of heated matter being here provided, since in the
case of the lias, the peculiar relics of organic beings found in its
strata, and the mode of their arrangement, shew that they were
in great measure formed in estuaries, and in shallow waters.
But the fault here is rather in the argument than in the the-
ory, and we shall therefore state briefly the difficulty which
really embarrasses it. ‘To account for the elevation and protru-
sion of large quantities of melted stoney matter, by the action of
any of those forces usually supposed to operate in volcanic
eruptions, such as gases or steam suddenly generated, and ex-
cited to powerful expansion by intense heat, we require some
external covering, which by vaulting over the heated nucleus,
may hold in the elastic vapours until their explosive energy has
been sufficiently augmented to enable them to burst at the
weakest point the retaining shell, and to force through the
opening the nearest portion of the melted matter in which their
pressure has been exerted. In all recent eruptions, whether of
basalt or of lava, this retaining force is exerted by the great
mass of the secondary and tertiary strata, but if we attribute a
secondary origin also to gneiss, with what are we to suppose
that granite, appearing as it does at almost every point of the
earth’s surface, was coated, and if uncovered, in what way was
its elevation effected? Surely then we have reason to think that
there may have been an epoch when gneiss rocks alone were in
being, and to examine, therefore, with attention the theory of
Cordier, and of De Beaumont, which consistently begins at that
point. According to it we should suppose the external crust of
the heated globe cooling and consolidating more rapidly than
the internal mass. It would then begin to contract and press
on the heated or melted matter within, until fractured by its re-
sistance to further pressure ; and in this way we should have a
stratified rock, such as gneiss, formed before any great expul-
sion of the unstratified could be effected. Nor does the divi-
sion into thin strata of this rock militate against our view of the
subject, since we can readily imagine the formation in the first
instance of a very thin layer, which would yield immediately to
pressure, and suffer by the fracture only a moderate degree of
disturbance ; then of another and another within it, each layer
by accumulation adding to the retentive power of the crust, and,
consequently, to the magnitude of the effort necessary to burst
128 Bibliographic Notices.
it asunder. But we shall pursue this inquiry no further, since
it is certain that on whatever principle we base our theories, the
fact that in secondary rocks formed, as the abundant relics of
organic beings testify, at moderate depths, we do not find ex-
act types of the primary crystalline strata, which we believe to
have been formed at great depths, does not in any way remove
the latter from the strict analogies of nature, as displayed in its
operations at all periods and in all places.
Quitting the consideration of primary rocks, we shall now
briefly advert to another great class, the several members of
which have in common this striking feature of resemblance—
that they contain the relics of animal life, either in forms now
no longer existing, or in those still familiar to us; we allude to
the successive formations of stratified limestone. Before, indeed,
the study of organic fossils had attained that degree of perfec-
tion which now characterizes it, the searcher for analogies
would have met in these rocks a serious stumbling block, but
modern observation and discovery have afforded a clue to every
difficulty. Our author, im his Memoir on the recent Fresh
Water Lake Iormations of Scotland, read before the Geological
Society of London, and published in its Transactions, detailed
the process by which limestones were, as heretofore, produced
by the gradual accumulation of the exuviee of testaceous mollus-
ca, and in the preceding volumes of this work, he brings for-
ward many examples of more extensive formations of the same
kind : .but were the superficial extent of such deposits even more
considerable than it generally is, we should have (excepting oc-
casionally in coral reefs) few means of deciding their thickness,
To future generations must be left the determination, for it is
more than probable that they will see these now hidden strata
elevated in their turn to light; and in our inquiry we must be-
gin with the strata next im order, (or those most receutly up-
lifted), and endeavour, if we can, to connect them with the pre-
sent order of things. The tertiary strata afford us the desired
link of connexion, as in the several parts of that truly interest-
ing series of deposits, we find a gradual approximation in the
characters of the imbedded organic fossils, to those of still liy-
ing testacea, until in the more recent strata they become, in the
greater proportion identical. In like manner also in their su-
perficial extent they may be considered intermediate between
the widely spread masses of the secondary strata, and the small
patches of recent lacustrone deposits.
‘The fossil remains,” says our author, ‘‘ which characterize each of
the successive periods alluded to, approximate more nearly to the as-
semblage of species now existing, in proportion as their origin is less
Lyell’s Principles of Geology. 129
remote from our own era, or in other words, the recent species are
always more numerous, and the extinct more rare in proportion to the
Jow antiquity of the formation.”— Page 21.
And when asking whether no passage can be traced from
the most recent fossil condition of the once animate creation, to
that which now prevails, he replies,
“‘Tt will appear in the sequel, that such monuments are not
wanting, and that there are marine strata entering into the composi-
tion of exensive districts, and of hills of no trifling height, which
contain the exuvize of testacea and zoophytes, hardly distinguishable
as a group from those now peopling the neighbouring seas. Thus
the line of demarcation between the actual period and that imme-
diately antecedent, is quite evanescent, and the newest members of
the tertiary series will be often found to blend with the formations
of the historical era.”—p. 22.
The limited range, also, of tertiary deposits, when tested
by the organic remains they respectively contain, is at once a
consequence and a proof of the gradual change of circumstances
effected by their elevation.
‘“‘ Jt is evident that large parts of Europe were simultaneously
submerged beneath the sea, when different portions of the secondary
series were formed; because we find homogeneous mineral masses,
including the remains of marine animals, referrible to the secondary
period, extending over great areas: whereas, the detached and isola-
ted position of tertiary groups, in basins or depressions, bounded by
secondary and primary rocks, favours the hypothesis of a sea inter-
rupted by extensive tracts of dry land.”’—p. 23.
Could we indeed watch the change from a wide spread
ocean, offering no barrier (except what might attend climate
or temperature) to the extension of marine animals; to that of
numerous smaller seas, estuaries, and lakes, cut off from each
other by large tracts of intervening land, we should have no
difficulty in seeing why
‘* The organic remains would be also more varied ; for in one lo-
cality, fresh water species would be imbedded, as in deposits now
forming in the lakes of Switzerland, and the north of Italy: in
another marine species, as in the Aral and Caspian: in a third re-
gion, gulfs of brackish water would be converted into land, like
those of Bothnia and Finland in the Baltic: in a fourth, there might
be great fluviatile and marine formations along the borders of a chain
of inland seas, like the Deltas, now growing at the mouths of the
Don, Danube, Nile, Po, and Rhone: along the shores of the Azof,
Kuxine, and Mediterranean.” —p. 25.
VOL. Vv. NO. 13. s
130 Bibliographic Notices.
And -
‘‘ If such be, in a great measure, the distinction between the cir-
cumstances under which the secondary and tertiary series originated,
it is quite natural that particular tertiary groups should occupy areas
of comparatively small extent.”
We might, even from these considerations, derive a_whole-
some caution in the application of organic remains in such strata.
as the lias, as a test of age, since, with our author, we may
fairly believe that they do prove the existence of similar cir-
cumstances, but not that those circumstances existed at the same
moment of time. It would be impossible in our limited space
to follow our author through all the details of this beautiful, and
we may say, new-born portion of geological science ; which,
since it was brought fairly into light by Cuvier and Brongniart
in their description of the basin of Paris, has grown, with every
step of its development, more interesting and more important.
He distinguishes in the tertiary strata four distinct periods,
for which he constructs names, founded on the approximation
in number of species of testacea identical with those now living ;
viz., pliocene from rAswv, major, katvoc, Tecens ; miocene,
from pewy, minor, and kavoc, recens ; eocene, from qwe, au-
rora, and catvoc, recens, because the extremely small propor:
tion of living species contained in these strata, indicates what
may be considered the first commencement, a dawn of the ex-
isting slate of the animate creation; the four divisions being,
therefore, the newer pliocene, the older pliocene, the miocene,
and the eocene ; and when we reflect that all these divisions
and their strata, are subsequent to the chalk, we must feel no
small degree of admiration at the rapid progress, within our
own time, geological science has made. .
The numerical proportion of shells in these stages of the terti-:
ary period identical with living species, is as follows: Ist, thir-
teen still living, and common to all the periods; 2nd, of the
newer pliocene species nine-tenths are recent, or still living ;
3rd, of the older pliocene more than half, of the miocene more
than a third, and of the eocene about a thirtieth part. The
evidence therefore afforded, by the fossil remains of the tertiary
strata, of a gradual approximation to the present order of things,
is striking, and when we further consider their occasional great
thickness, for instance, in the sub-Apennine deposits, or even.
in those of the Isle of Wight, where, according to Mr. Webster,
as quoted by Mr. Bakewell, «the whole thickness of the beds,
at Alum Bay, which are nearly vertical, is not less than three
thousand feet, comprising fourteen hundred: and eighty-one
feet of strata abave the chalk,” we shall have no hesitation in
Lyell’s Principles of Geology. 13d
admitting, that the analogies of nature have suffered no sudden
and absolute break, but are traceable by similar operations
through the whole chain of geological evidences. If, too, we
have referred to the operations of elevating forces for an expla-
nation of some of the changes in the characters of sedimentary
deposits, so also, we may see in the connection of those elevations
with strata so recent, a proof that the same causes have con-
tinued to act almost, nay up to our own times ; and taking into
consideration the effect of modern earthquakes, we may add do
still act. That, however, the very exercise of any particular
force may in time produce a modification of its action, cannot
in sound philosophy be denied, and we, therefore, are not sur-
prised to observe that our author defends himself from the
charge of having
‘‘Endeavoured to establish the proposition, that the existing
causes of change have operated with absolute uniformity from all
eternity.” —Page 383.
We shall now, though with regret, conclude our observations,
hoping that we have sufficiently elucidated the principles of this
great work, to satisfy our readers, that in its pages the philoso-
pher may find matter for the sublimest speculations, whilst the
practical geologist will see his science assuming a more perfect
and pleasing form, and, imbued by the spirit it inculcates, carry
with him to the field a power of generalization, which will mar-
shal into order the most strange and discordant appearances of
nature.
JosrepH I. Porttock.
SCIENTIFIC INTELLIGENCE.
CHEMICAL AND PHYSICAL SCIENCE.
On the Development of Heat in the Flowers of the Caladium
Pinnatifidum, by Doctor E. H. Schultz of Berlin.— Dr. Schultz gives
the following account of experiments made by him to ascertain the
elevation of temperature in the flowers of the Caladium pinnatifidum.
‘On the Ist of May this year, at mid-day, I had one of the flowers,
which was beginning to burst, cut off from the plant, and found
before and immediately after the separation, that the temperature
of the flower was completely the same with the temperature of the
air in the hot-house. I took the flower home with me, and placed it
with the cut end of the stalk in a glass of water, in order to observe
the phenomena during the period of its blooming. The temperature
of the room was 13° R. (61°.2 Fahr.), and the flower had likewise
the same temperature until about five o’clock in the afternoon. About
six o'clock, the flower, which had been previously without any smell,
gave out a very powerful odour that reminded me of trying the tem-
perature. This had risen 2°; for that of the flower was 15° R. (65°.
{ Fahr.) At seven o’clock’ the temperature had risen to 17° (70°.2
Fahr.) At eight o’clock to 19° (74°.7 Fahr.) ; half-past eight, 191°
(76° Fahr.). At nine o’clock 204 (78° Fahr.) At ten o'clock 211°
(81° Fahr.) ; and this appeared to be the greatest height, since there
seemed to be no farther increase up to eleven o'clock. During this
elevation of temperature, the disengagement of the odour likewise
increased ; this became so powerful that the whole room was impreg-
nated with an ammoniacal vapour. In the morning the temperature
of the flower had again fallen to the temperature of the air. During
the following evening no further elevation of temperature was mani-
fested in this same flower. But, on the contrary, with other flowers
which bloomed at a later period upon the same plant, there was the
same gradual elevation of temperature and disengagement of odour,
which afterwards, during the evening and night, impregnated almost
the whole of the air in the hot-house. When this observation is
compared with that of Lamarck and Senebier upon the Arum Itali-
cum, and of Huber upon the Arum cordifolium, there appears a most
striking difference in the period of the disengagement of the caloric ;
likewise in the quantity of caloric, which in the case of the Arum
cordifolium rose from 19° to 44°, therefore25°. Senebier found in
Scientific Intelligence. 133
Geneva the highest temperature in the Arum Italicum to be deve-
loped at a quarter before seven in the evening, On the contrary, ac-
cording to Bory de St. Vincent, the greatest elevation of temperature
of the Arum cordifolium in Madagascar shows itself in the morning
after sunrise about seven o’clock ; and from eight o'clock the tempe-
rature gradually declines until the flower decays ; so that in the even-
ing the temperature of the flower differs but little from that of the
atmosphere.”
The Caladium pinnatifidum, which in Berlin shows the highest
temperature of its flower about ten o’clock in the evening, grows wild
in the shady forests of Caraccas. Hence it is possible that the periods
of its disengagement of caloric, as well as the periods of its blooming,
generally regulate themselves according to the peculiarity of the vege-
tation of the plant, as well as according to the climate of its native
country.— Edinburgh New Philosophical Journal, Jan. 1834.
On the Reduction of Mr. Faraday’s Discoveries in Magneto-
Electric Induction to a general Law, by the Rev. William Ritchie,
LL.D. F.R.S.—The law is founded on the universal principle that
action and reaction are equal. Thus, if voltaic electricity induce
magnetism under certain arrangements, magnetism will, by similar
arrangements, react on a conductor, and induce voltaic electricity.
Instead of stating the law of magneto-electric induction, and then illus-
trating it by experiment, it will be more instructive to arrive at it by
a process of induction.
1. Ifa piece of soft iron, N S, be made to approach rapidly a vol-
taic conductor, and at right angles to its direction,
the soft iron will be converted into a magnet
having its poles developed at N S, according to
the direction of the voltaic influence. If the bat-
tery, ZC, be removed, and the ends of the wire
connected with the zinc and copper plates bronght
into metallic contact, and if the piece of soft iron
be again converted into a magnet by means of
a permanent horse-shoe magnet, the wire will have the same voltaic
state induced on it as it had when connected with the battery.
If a temporary magnet be merely a piece of soft iron having the
electricity essentially belonging to it arranged in a particular direc-
tion, it is obvious that the motion of the atoms of the electric fluid
will take place in the opposite direction, when the iron is ceasing to
be a magnet or returning to its natural state. Hence the direction
of the voltaic influence induced on the conductor will, as Mr. Faraday
has shown, take place in the opposite direction.
2. If two conductors, having electricity induced in them in the
same direction by means of an elementary battery, be placed parallel
to one another, they will be mutually attracted. Hence, if we re-
move one of the batteries, and connect the ends of the Wires as in
the first experiment, and then imitate attraction, by making the
wires rapidly approach each other in a parallel position, the same
134 Scientific Intelligence.
electric influence will be induced on the closed circuit as it had
when connected with the battery. If the conductors, when con-
nected with the batteries, have their electricities induced in opposzte
directions, they will mutually repel each other. Hence, if we remove
one of the batteries, connect the wires as before, and zmitate repul-
sion, by removing the wires rapidly from each other, the electric
influence or current will be induced in the same direction as it was
when the wires were connected with the battery.
3. If a voltaic conductor be made to revolve round the pole of a
magnet, as in Mr. Faraday’s first experiment on rotation, and if the
battery be removed and the ends of the conductors brought into
metallic contact, the same electric state will be induced on the closed
circuit, by turning the wire rapidly round the pole of the magnet by
mechanical force.
4, If we produce all the rotations described in works on electro-
magnetism, and if we remove the battery, and bring the ends of the
conductors into metallic contact, and then contenue the rotation by
mechanical means, the same electric state will be induced on the con-
ductor which it had when connected with the battery.
In a paper of mine read before the Royal Society on the 21st of
March, 1833, I first described the method of making a piece of soft
iron or electro-magnet, either straight or in the form of a horse-
shoe, revolve rapzdly round its centre, either by the action of the
earth, or of a horse-shoe magnet, by changing its poles twice in every
revolution. Hence from the general law it follows, that if the soft
iron be made to revolve by mechanical force, the same electric state
will be induced on the conductor as it had when the ends of the
wires were connected with the battery.
These facts were known, and the experiments publicly exhibited,
months before the large revolving electro-magnet was exhibited in
the Adelaide Rooms. The general law at which we have arrived
may be thus expressed: “‘ [f a wre, conducting voltaic electricity,
produce, by zits action on magnets or conductors, certain motions, as
attractions, repulsions, or continued rotation; and if the battery be
removed, the ends of the wires brought into metallic contact, and
the same motzons be produced by mechanical means, the conductor
will have the same electric state induced on it, as tt had when con-
nected with the battery.” —Lond. and Edin. Philosophical Maga-
zene, Jan. 1834.
On the continued Rotation of a closed Voltarc Circuit, by
another closed Circurt, by the Rev. William Ritchie, LL.D., F.R.S.
—M. Ampere has demonstrated that when a closed circuit (or a con-
ductor of voltaic electricity returning into. itself so as to form a
complete circuit) is acted upon by another closed circuit, there is a
determinate position in which stable equilibrium takes place. Hence
che impossibility of producing continued rotation by the mutual action
Scientific Intelligence. 135
of two closed voltaic circuits, Hence, also, the impossibility of pro-
ducing continued rotation by the mutual action of two permanent
magnets. But though continued rotation cannot be produced by
fied action of closed circuits, when the voltaic influence is exerted
in a particular direction, I have succeeded in producing such rotation
by changing the direction of the voltaic influence; a short account of
which may “not be unacceptable to the readers of -the Philosophical
Magazine.
The description of the method will he easiest understood by refer-
ence to the annexed figure.
Let AB represent the section of a circular pene of mead, having a
groove measuring about an inch in its inner —
diameter, and half an inch broad, for the pur-
pose of holding mercury. ‘The groove is divided
into two compartments by small slips of wood
fixed diametrically opposite to one another.
These compartments may be connected by means
of wires with the plates of an elementary
battery. A glass rod, having a small cup, c,
at the top, is cemented into the centre of the sole of the apparatus.
A fine copper wire, covered with silk, is formed into a rectangular
coil or closed circuit, as in the figure, the ends of which, a b, dip
into the mercury SMotgiaadsd in the compartments. The lower hori-
zontal branch of the rectangle has the wires separated so as to form
an opening for the glass red to pass through it, in order that the
rectangle may hang perpendicularly. A similar rectangular closed
conductor is supposed to be connected with the poles of another
battery.
lf the last conductor be placed above that represented in the figure,
but not parallel to it as in the case of stable equilibrium, the moveable
conductor will turn round till that position be gained. But the
moveable conductor being put in motion will pass this position the
moment the ends of the wires, a 6, pass above the two divisions in the
groove, so that the direction of the voltaic influence is changed, and
the moveable conductor forced round another semicircle, when the
direction of the influence is again changed; and so on, producing
continued rotation. By using a magnet instead of the closed con-
ductor a more powerful and rapid rotation may be produced. By
placing the divisions in the magnetic meridian, the closed conductor
may be made to revolve by the action of the earth.
This experiment, if I mistake not, will afford an interesting illus-
tration of the mutual action of voltaic conductors, and of the striking
analogy between a permanent magnet and a closed circuit conducting
voltaic electricity.—Jbid.
Composition of Mummy Powder.—The following analysis of
this powder has been submitted to the Royal Academy of Medicine
by MM. Boudet, Boutron, Charlard, and Bonastre, who had been
136 Scientific Intelligence.
charged by the Academy to examine the composition of an Egyptian
mummy :
1. A resin entirely soluble in alcohol, and the characters of
which could incline one to consider it asa aGGes of turpentine which
had been acted on by fire ;
2. A gum resin presenting all the properties of myrrh ;
a Fragments of fruits, which by their appearance and analysis
presented the greatest similarity to those of the nutmeg ;
4. Chloride of sodium and of lime;
5. Lastly of a particular crystalline substance, belonging, however,
to the mummy, and which analysis shewed us to be human margaric
acid.
To the above analysis the following note is appended regarding
the cinnamon of the ancients ;
We might here easily recognize cennamomum if by cinnamo-
mum we were to understand canella; but Herodotus was perfectly
well acquainted with canella; he designated it, not by the name
xiyveuapeov, a word he never made use of, but by the term ~«ez, which
means small, dry, slender branches; and the Arabs at this very day
call canella herfé or gerfeh. Thus for about 2250 years, canella was
known in Egypt under the name of x#e@n. What can it then be but
cinnamon ?
The ancients supposed that the x:vapewuov originally belonged to
those places where Bacchus was brought up, and that his name was
given to it by the Phoenicians who received it from the Arabs. Now
Bacchus’ country is India, with which the Arabs communicated
by means of the Red Sea. Desfontaine thinks that it is not possible
to know the country whence cinnamon was derived, and that we cannot
know to what tree the cinnamon belongs. Some authors think it to
be the canella. Sprengel thinks it to be our Laurus connamomum.
Stackhouse, on the contrary, conceives it tobe Laurus Cassia. One
of us, according to this analysis, which is in part confirmatory of the
account given by the historians of antiquity, conceives that in the frag-
ments of fruits resembling nutmeg we probably see the real cinnamon
of the ancients.”
Preparation of the Proto-tartrate of Mercury and Potash, by
M. Carbonell.—M. Carbonell, who has paid particular attention to
the treatment of syphilitic diseases, ascertained the antisiphilitic
preparation of Pressavin (rob antisiphilrtique de Pressavin) from
which he derived the most signal advantage, owes its efficacy entirely
to one of its ingredients called by Pressavin eau vegeto-mercurrelle.
This was merely a liquid arising from the combination of the oxide
of mercury and cream of tartar by means of heat. M. Carbonell
discovered, that the cream of tartar dissolved, with the help of heat,
the oxide of mercury ; that thence there resulted two salts perfectly
distinct, on the one side a simple salt, the tartrate of mercury, and
on the other a double salt, which may be called the proto-tartrate
Scientific I ntelligence. 137
of mercury and potash. The following is what takes place during
the action of tartrate of potash on the oxide of mercury. The excess
of tartaric acid unites with the oxide forming tartrate of mercury,
which is in part precipitated on cooling, whilst there is formed ano-
ther salt, the proto-tartrate of mercury and potash, which remains
in the liquid, and may be obtained by evaporation. The author's pro-
cess is as follows:
1°. An intimate mixture is to be made by means of long con-
tinued trituration, and by adding a small stream of water, of one
part of the protoxide or deutoxide of mercury, precipitated from the
nitrate of that metal. This mixture is to be thrown by small pro-
portions into an earthen pan, capable of containing at least sixteen
pounds of boiling water for two of the mixture. This solution is to
be passed, while hot, through a filter prepared on fine linen, which is
to be placed in a frame of wood.
2°. This liquid being filtered, is to be made to crystallize, or else
evaporated to dryness, taking care to Separate all the tartrate of mer-
cury which is precipitated, or separated under the form of pellicules
or crystals ; which is to be collected by means of a wooden or ivory
Spoon, as it presents itself. This operation is to be repeated as often
as is necessary, especially at the end of the operation. The saline
liquor concentrated, s9 as to give 30 degrees to the areometer of
Baumé, and well filtered, contains no more or hardly any tartrate
of mercury. Evaporation. may then be continued to dryness, or
made to crystallize, (if the liquor marks 52 degrees to the areometer
above mentioned in forming pellicules) and the result is a proto-tar-
trate of mercury and potash, and very pure, crystallized or not.
3°. The evaporation to dryness may be made in a glass or var-
nished earthen-ware vessel, which is to be placed in a'sand bath on a
slow fire, or rather a water bath, so that the, salt should not be altered
or decomposed. The liquor is then to be left to dry, atthe heat of the
Same evaporating bath, and excluding the light. . It may be also
obtained crystallized in tables, by exposing the saline liquor reduced
to the least volume to a moderate heat, or what is preferable toa
stove, “i
4°, The salt obtained ought to be enclosed in crystal flagons her-
metically sealed, so that the salt, may not attract humidity from the
air, and these flagons ought to be covered with black paper, or en-
veloped in cloth of the same colour, for the salt might be easily al-
tered, as happens in different preparations of mercury.
As to its medical use, the proto-tartrate of mercury and potash
may be given dissolved in water, with the addition of mel rose or
Some syrup, provided it be not acid. It may also be given in the
form of pills, made up with a little mucilage or extract, such as ex-
tract of Peruvian bark, It may be combined again with advantage,
with the extracts of henbane, and wolfsbane, for complicated vene-
real pains, rheumatism, and again with the magistery of sulphur,
when there is a complication of the herpetic virus.—Journal de
Pharmacie, Nov. 1833.
VOL, V. No. 13. T
138 Scientific Intelligence.
NATURAL HISTORY.
Peculiarity in the Respiration of the Crocodile, by Captain
Portlock, R.E., F.G.S., M.R.1.A.—In investigating the natural pro-
cesses by which animal life is sustained, we must be cautious not
to attach more importance to the organ, as an organ, than to the
function which it is destined to perform, as in doing so we may check
our progress in the discovery of other modes of effecting the same
object. In respiration, for example, the function to be performed
is the separation of oxygen from the air, either of the atmosphere,
or contained in water, and of carbon from the blood; and though the
ordinary instruments for effecting this exchange may be lungs, gills,
or tracheze, it by no means follows, that there are no other methods
of spreading out the minuter blood-vessels, and facilitating the mu-
tual action on each other of the blood within and the air without
them. The numerous air-lets of birds may in part aid the func-
tion of respiration, and the trachez of insects may be considered as
lungs, spread generally over the body, and operating directly on its
fluids. We make these remarks, in order to introduce the passages in
the “ Cours de l’Histoire Naturelle des Mammiferes,” by M. Geof-
froy St. Hilaire, which describe a peculiar modification of the respi-
ratory organs in the crocodile. After pointing out the unreasonable-
ness of supposing, that those parts of the animal structure, the use of
which we have not as yet discerned, are indeed without a use, and
that those peculiarities in habits or manners of animals, which at
times seem inexplicable, are without a cause in the animal structure,
because we have hitherto failed to find it, he observes, page 9 :—
‘“‘ In this position, as regarded the crocodile, I found myself, for
the observations of the ancients, and also of modern travellers, had
represented him, when on land, as an animal so timid, that it was
with wary caution he stole upon his prey, casting himself, on the
least alarm, into the water; but when immersed in the water, as
one so bold, vehement, and fearless, that he became the terror of
all other animals. Reflecting on these facts, and considering that
no extraordinary development of vital energy is possible, unless ex-
cited and supported by an equally powerful respiration, I was induced
to inquire, how an animal breathing by lungs, fitted as they are for
an aerial medium, should acquire this augmented respiration in an
aqueous one. At length | discovered that there was a cause for the
apparent anomaly, and that cause a most curious modification of
organization, through which the crocodile enjoys not only the ad-
vantages of its ordinary means of respiration, as an animal breathing
air, but of those also which are possessed by a large portion of aqua-
tic animals. They breathe, when immersed in water, like the holo-
thuria; their abdomen being converted, as it were, into a vast aqua-
tic trachea.” And again, page 28, ‘‘ Such indeed is the case of the
Scientific Intelligence.. 139
crocodile ; he possesses a lung more perfect than that of any reptile,
and yet is little excited by its use, for on land, where the resources of
his pulmonary organization are called into action, he is timid, feel-
ing them insufficient to answer the demands of his instinctive feroci-
ty. But let him enter the water and he is a changed creature: in
that medium his vigour is extreme, his swimming rapid, and by the
exhibition of all the ardour and force of a lion, he displays the energy
which attends powerful respiration. Nor can it be in its pulmonary
organization that the crocodile finds support for this excess of activity,
since that organization has been found on land insufficient to such a
purpose, whilst its use in water is necessarily suspended. Auxiliary
organs enter into function : the crocodile breathes in water in the man-
ner, and by an organization very similar to that of the holothuria : all
the blood-vessels of the abdomen are made to participate in the effects
of respiration. Water enters into that cavity by means of two canals,
which beginning in the cloaca, end in the cavity of the peritoneum.
The crocodile has an abdominal, as well as a pectoral sternum; each
sternum and its muscles regulate the effects of its peculiar aud respec-
tive respiration, the pectoral sternum being called into action on
land, the abdominal in water.” |
M. St. Hilaire ascribes the discovery of the canals of communica-
tion between the cloaca and peritoneum to MM. Isidore Geoffroy
St. Hilaire and Joseph Martin, and after some reflections on the
singular beauty and simplicity of this provision of nature, by which a
sluggish animal becomes endowed with life and energy, he concludes,
page 30, “‘ the peritoneal canals are a species of ‘ trachée-artére’, to
introduce the respiratory element into another and peculiar cavity
adopted to the objects of respiration.” We trust the preceding ex-
tracts may excite the attention of those gentlemen, and there are
many in this city, who from their profound knowledge of comparative
anatomy, are well fitted to illustrate the subject of respiration, and
that some one of them may be induced to read before the Zoological
Society, at one of its scientific meetings, a comprehensive memoir on
the ordinary and extraordinary modes of effecting so important a
function.” |
ANATOMY AND PHYSIOLOGY.
Causes of the Presentation of the Head in Accouchement.—
M. P. Dubois read a work entitled: “A Memoir on the Cause of
* We beg to refer to Professor Grant’s admirable lectures on comparative ana-
tomy, now publishing in the Lancet, for some important facts connected with the
respiration of the holothuria, and also of alligators, which lead him to differ from
the views entertained by Geoffroy St. Hilaire.—See Luncet, Feb. 1st, 1834.—Ep.
140 Scientific Intelligence.
the Frequency of Head Presentations, and on the Instinctive and
Voluntary Movements in the Foetus.” The author first examines the
question, why at the ordinary term of gestation, and even some time
before, the foetus is placed in the uterus with the head down and bent
a little on the chest. He combats the opinion of the ancients, almost
entirely forgotten at present, of the tumble which the foetus was sup-
posed to make between the seventh and eighth month. He then
passes on to the opinion now generally admitted, that the weight of
the head of the foetus draws this part down, and that the insertion of
the umbilical cord at a part nearer the pelvis than the head, admitting
that the child is suspended by this cord, must favour the inclination
of the head downwards, as happens in the heaviest scale of a balance.
M. P. Dubois is not exact in saying that the weight of the
head is heavy enough to produce this effect. When we immerse
dead foetuses of different ages in warm water, scil. from the fourth
to the ninth month, after having placed them by means of strings
in the position they hold in the uterus, the head does not gain the
bottom sooner than the rest of the body. Ifthe experiment is made
in a common bathing-tub, the fall being slower in consequence of the
mass of liquid, we observe all parts to descend with equal velocity,
and if the foetus be placed horizontally on the water, it preserves the
position to the bottom: the back and shoulders are the parts which
usually touch the bottom of the tub first. On the other hand it is
supposed, that on dividing the body of the foetus into halves, the
weight of each must nearly balance ; for if the brain is very large, the
liver which is not less so, the intestines filled with meconium, and the
bladder containing some urine, will nearly produce an equilibrium.
In fine, the small capacity of the cavity of the uterus, and the small
quantity of the:waters must still weaken, instead of fa ouring, the in-
fluence attributed to the oreater weight of the head of the foetus.
M. Dubois next combats the supposed suspension of the child by the
eord. At two months and half, and even before that period, the cord
is already longer than the foetus and entire ovum: on this hypothesis
it would be necessary that the placenta should be always inserted at
the fundus of the uterus; in the cases where the cord is rolled
round the child’s neck, the pelvis should always present itself to the
orifice of the uterus: now we know by experience that it is not so.
In women who by reason of particular circumstances keep a horizon-
tal position for almost the entire time of their pregnancy, head pre-
sentations are not less frequent than in others. Acephalous foetuses
should always present the pelvis; but it is not so; and though with
them the presentation of the head is less frequent than in well-formed
foetuses, the preponderance of the pelvis is here but accessary, as we
shall see farther on.
If we admit the influence of weight, we must necessarily admit
that it is exercised particularly in the first months of gestation, during
which the waters are more abundant, and the head of the foetus is
proportionally more developed. Now it is principally before the
seventh month that the head presentations are less frequent in com-
Scientific Intelligence. 141
parison to the others, as is proved by the following results obtained
at the Maternité.
Children born before seven months. Vertex. Pelvis. Shoulder.
1829, : : 30 . ‘ a2 s d : l
Weert meee ic 35 Alin it ed, ern 1
183], . ; 23 , 13 ; 9 4 l
1832, : e 24 $ , 14 ah A 2
112 65 dl 3
The last was expelled before we could ascertain the presentation.
Thus in 121 deliveries before the seventh month, sixty-five were
head presentations, fifty-one by the pelvis, and five by the shoulders.
The births by the pelvic extremities are then in the proportion of
four to five, or of sixteen to twenty, whilst at the ordinary period of
nine months, the proportion is in general one to twenty. In fine, in all
mammiferous animals, whatever be the conformation of the uterus,
the foetus presents almost always by the head, though the inclination
of the organ towards the end of gestation is opposite to that of the
uterus in woman. On examining some foetuses of cats, rabbits, &c.,
we immediately perceive that the predominance of the abdomen in
the foetuses of quadrupeds, which has been admitted to explain this
fact, is not real, and that the head in those animals is as developed as
in the human foetus. From these facts the author concludes, that
the position of the head of the foetus in the uterus is not at all deter-
mined by the force of gravity. He conceives that the causes of this
position ‘‘ reside in the want or desire which nature has impressed on
the foetus, to be at a certain period of pregnancy in the situation in
which it is found, and in a sort of instinctive or voluntary action,
which brings it there when it is accidentally removed from it.” M.
Dubois enters here into the examination of the question, whether
there exist instinctive or voluntary movements in fcetal life. It is
said that the foetus enjoys only vegetable life. The author remarks,
that if it be denied that the movements of certain parts of vege-
tables are the result of spontaneous determinations in the indivi-
dual, we cannot refuse to admit them as such in zoophytes, whose
existence is purely vegetable. Ifthe imperfection of the organs of
the human foetus be alleged, he replies, that certain animals which
continue foetuses a long time after birth, as the tadpole, caterpillar,
&c. have, in spite of the imperfection of their foetal organization, no
loss of instinctive and voluntary determinations, which it is impossi-
ble to deny: thus the tadpole swims with rapidity in pursuit of its
prey ; the caterpillar spins the shell in which it is enclosed.
The author, to answer the objection that the foetus, removed from
external agents, receives no impressions, examines the movements of
the infant enclosed in the womb, and their causes. He states, that
the application of the hands to the abdomen of the mother, particu-
larly with pressure, and the apposition of the finger to the head of
142 Scientific Intelligence.
the child through the os-uteri, towards the latter part of pregnancy,
or during delivery, very often give rise to well-marked movements in
the latter. On the other side it is observed, that the motions of the
foetus are repeated in a great number of cases in certain conditions,
such as great changes in the situation of the mother, certain attitudes
in the interval between meals, particularly when it is long. In fine,
when during pregnancy or labour the funis is compressed, the feetus
seems to indicate, by repeated movements, the feeling of constriction
which it experiences, and the wish to be removed from it. If the
pressure be continued, these movements are succeeded by efforts to
respire, which, according to circumstances, cause air cr some of the
waters to enter the lungs. To all these proofs of the existence of in-
stinctive and voluntary movements in the foetus, there are joined
those furnished by the foetus of animals, such for example as the act
of the bird, which when come to the term of incubation, breaks its
shell to get out of the egg. As to the internal cause which excites
those determinations, the author acknowledges that it is unknown to
him.
M. P. Dubois then meets some objections which might he raised
against this theory. The most important is this: how, if the position
of the foetus in the uterus is the result of instinct, do dead feetuses
present it as well as those alive? To answer this argument we must
distinguish three epochs in pregnancy, during which the footus may
be expelled: the first including from the commencement of the fourth
to the commencement of the seventh: the second, all the entire
seventh month, and the third, the eighth and ninth months. We
have seen above, that living or dead foetuses expelled before the
seventh month, are born almost as often by the pelvis as by the head:
the objection then does not hold regarding this period ; when with
respect to the foetuses who have died during the third period, it ts sup-
posed that they have had time to assume this position, and that once
taken this position cannot change by reason of the closing of the
uterus : yet even the death thus slow increases much the chances of
presentation by the pelvis, as the following cases prove : out of ninety-
six foetuses which died during the third period, and were born at the
Maternité, for the last four years, seventy-two presented the head,
twenty-two the pelvis, and two the shoulder. The ratio between the
pelvis and head presentations was as one to three-fourths. If the
foetus dies during the seventh month, there is as much chance fer one
presentation as the other. During these same years, out of forty-six
children which died under these circumstances, twenty-one presented
the head, twenty-one the pelvis, and four the shoulder. This very
remarkable result becomes still more so, when compared with that of
the births of living children in the same period. In fact, out of
seventy-six children born alive at seven angele sixty-one came by
the head, ten by the pelvis, and two by the shoulder. Whence it
follows, that at the seventh month the pelvis dtesuchneink are to those
of the head, as one to six, and for the dead feetus as one to one.
‘So that, says the author, the influence of life cannot be doubted,
Scientific Intelligence. 143
and, consequently, the influence of instinctive determinations on the
ordinary situation of the fee isk in the uterus.’—Archiv. Gen. Fe-
bruary, 1833.
On the- Development of the Hair and Wool.—Academy of Sci-
ences, sitting of the 21st October. M. Virey sends a memoir, en-
titled: Physiological and Pathological Gbservations on the Develop-
ment of the Hair and Wool, in furred and fleecy Animals ; with the in-
tention of proving that their production is favoured :
1. By the diminution of the nervous sensibility, or by its con-
centration.
2. By cold, dulness, sleep, &c.
3. By a diminution of cutaneous transpiration.
4, By a weakness of the respiratory functions.
5. By relaxation, and a sedentary and idle life, under that tepid
and slightly humid temperature which proiongs the hair.
6. By the disposition to albinoism.
7. ‘The fineness of the hair is greatly favoured by the tenuity of
the skin, youth, short stature, and short life, whilst frequent shear-
ing makes the wool coarse.
8, Light nourishment also favours the delicacy of the hair and
wool.
9. All that prevents the loss of of the animal forces, or increases
their vigour, thickens their coat, and increases the density of the:
hair.
10. It is particularly the genital ardour, or the least possible
abuse of that faculty, which ennobles the races, and which procures the
richest wool.—Aevue Med. Nov. 1838.
Action of the Heart.—There still remain for explanation two phe-
nomena, namely, the impulse of the heart against the wall of the
chest, and the double sound that is heard during its motions. The
impulse has, even up to owr own times, been attributed to the systole
of the ventricles, and the manner of its production variously accounted
for. The most simple supposition was, that the ventricles elongate
themselves so as to reach the wali of the chest, which, in man, is
about an inch from their apex: but it has been already proved, that
they shorten themselves during their systole, and, consequently,
rather retract than advance. Accordingly Senac, Hunter, and others
supposed that the arch becomes straightened during its sudden reple-
tion, in consequence of the obstruction the blood meets with, and
that as it cannot move backwards on account of the spine, it presses
forwards and drives the heart before it. But in the first place, as
Carson has remarked, it is not true that a flexible curved tube be-
‘comes straight when injected with a fluid; in the next place, it has
been proved that during the systole sg heart, the aorta is not
driven towards, but from ‘it, in the direction of the. current. of blood:
lastly, the aorta in many animals does not form an arch at all, and
yet the impulse is just as perceptible in these as in the others. Hal-
144 Scientific Intelligence.
ler, Having observed the apex turn up a little during the systole, in
consequence of its shortening, supposed that it struck the ribs while
thus bending and approaching the base; and most physiologists,
Soemmering and Treviranus among the rest, adopted this opinion
But I have never seen this turning up of the apex take place to such
an extent, as to allow me to attribute to it such an effect: besides, it
supposes a certain position of the heart with respect to the ribs, which
we do not find to obtain; indeed, such a result of the curving of the
apex, would be quite impossible in most of the mammalia, in which
the heart hangs perpendicularly, the base directed to the spine, and
the apex, to the sternum. Lastly, Senac and Carson supposed that
the apex although drawn backwards during the systole of the ventri-
cles, was yet immediately afterwards impelled forwards and towards
the ribs by the dilating auricles, and especially by the left, from its
pushing against the spine. But the filling of the auricles does not
take place with such a sudden shock as to cause the impulse of the
heart; and besides, the latter ceases suddenly, the heart itself evi-
dently falling backwards, while the former, which is assumed to be
the cause of the forward motion, not only continues, but even in-
creases. However this opinion, though untenable, serves to lead us
to another view, to which the insufhciency of all the theories that
account for the impulse of the heart by the systole of the ventricles,
is of itself enough to dispose us, namely, that lately brought forward
by Corrigan and Stokes, according to which the ventricles being
completely filled with blood by the systole of the auricles, and
brought to their greatest degree of diastole, are elongated, pushed
forwards, and pressed against the ribs, from which they again retreat
in consequence of their immediately succeeding systole. In order to
observe directly the nature of the impulse, I have performed many
vivisections on rabbits and horses; but the impetuous motions of the
heart, which under such circumstances confuse the observer, and so
quickly give place to the stillness of death as to demand the greatest
expedition, did not permit me to attain my object entirely ; and dur-
ing artificial respiration after the cessation of life, the stroke of the
heart in rabbits was too weak to reach the ribs. However, I have
convinced myself that the apex of the heart actually moves forward
during the systole of the auricles, and backwards during that of the
ventricles. In like manner Stokes remarked, that when the finger
was laid on the apex of the heart in rabbits, it was found to retreat at
each systole of the ventricles, and to advance at each diastole: in a
goat this motion amounted to two or three lines. A second ground
for this view is, that the arterial pulse is not simultaneous with the
impulse of the heart, but follows immediately after it. It is not very
easy to attain to certainty on this point; partly because the systole of
the ventricles follows so closely upon that of the auricles, that we
cannot always distinguish them even in the heart when lying before
our eyes ; and the retrocession of the heart succeeds so quickly to the
advance, that the entire appears a mere convulsive action: and partly
because it requires a considerable exertion to observe accurately two
Screntifie Intelligence. 145
objects at once with thé same sense, as the attention generally fixes
itself on one of them in preference. Any one can’make experiments
upon himself, by feeling the impulse of the heart with the right
hand, and the pulsation of the carotid, or of the right radial artery
with the left; and this method has the advantage that we can choose
a time when the beating of the heart is less frequent than usual, and
repeat our observations without disturbance. However, it is still
better to make them upon the horse, the action of the heart being
less frequent on that animal: the impulse is to be felt by applying the
hand to the thorax, while an assistant examines some artery, the
maxillary, for instance, and marks each pulsation accurately by a
noise or visible motion. In both these ways have I, as well as Cor-
rigan and Stokes, clearly distinguished occasionally, though not con-
stantly, the succession of the two strokes. But it is an important
fact, that it was previously recognized by observers whose judgment
was not influenced by any theoretic views; namely, by Soemmering,
according to whom the interval amounts to two-thirds,* and also by
Steinbuck. Magendie, who observed the same phenomenon, attri-
butes the later pulsation of the arteries to the circumstance that the
stroke of the heart requires a certain time for its propagation along
them; but though this might cause a perceptible difference in the
time of pulsation of the most remote arteries, it certainly could not
in those situated very near the pulsating organ. Besides, Pigeaux
has remarked of the arteries in general, that their pulse alternates
with the impulse of the heart against the ribs. Lastly, Stokes has
observed that the pulsation of the jugular vein, which is produced by
the systole of the right auricle, is exactly synchronous with the im-
pulse of the heart. Accordingly, we may consider it as demon-
strated, that the impulse of the heart depends on the diastole of the
ventricles, just as the pulse does on the diastole of the arteries.
With respect to the sounds heard on applying the ear to the re-
gion of the heart, different opinions have been entertained. Laen-
nec attributes the first, which is comparatively duller, stronger, and
of long continuance, to the systole of the ventricles; and the second,
which is clearer, weaker, and shorter, to that of the auricles.
Turner agrees with him as to the first sound; but thinks the systole
of the auricle is either not heard at all, or else synchronously with
that of the ventricles ; and that the second sound proceeds from the
collapse of the pericardium, or even from the diastole. Williams
explains the first sound as an effect of the systole of the ventricles
and auricles together; and the second as produced by the action of
the valves of the heart. According to Despine, the first depends on
the systole of the ventricles, and the other on their diastole. Lastly,
according to Corrigan, the first sound is produced by the systole of
the auricles, and the second by that of the ventricles. This opinion,
a
* A third dis the sixtieth part of a second.
VOL. Vv. No. 13. U
146 | Scientific Intelligence.
to which Stokes and Pigeaux also assent, is the only well-founded
one : still it has not yet been made sufficiently clear, an object which
perhaps will be more satisfactorily attained in the following eluci-
dation.
The sound in question, as it altogether follows the type of the mus-
cular action of the heart, must depend on that action, though not im-
mediately ; that is to say, it cannot proceed from the striking of the pa-
rietes of the organ against the blood during the systole, as the systole of
each part only ensues when that part is completely filled with blood, and
there is consequently no empty space remaining, by means of which
alone would the production of sound be possible. The sound can,
in fact, be caused by the systole only in as far as the latter drives
the blood in another cavity that is partly empty (i. e. that contains
some air,) where it rushes in a stream against the parietes. While
this conclusion forces itself upon us as necessary, from its very na-
ture, it is no less confirmed by the fact, ascertained by experiment,
that when air, injected into a vein, reaches the heart, the sound be-
comes unusually strong, and audible even to the by-standers. Nyssen
compared it to the noise produced by beating up white of egg with
water: and found it to be isochronous with the action of the heart ;
after a short time it ceased, the air having been taken up by the
blood. When Rosa and Scarpa had bled animals to exhaustion,
and then restored the action of the heart by the injection of the
blood of other animals, they heard likewise, without applying the
ear, a great gurgling, which could only arise from the meeting of
the injected blood, with an unusually great quantity of air that had
collected in the heart, in consequence of the over bleeding. But
the blood can cause a sound even in the vessels, when they happen
to contain a certain quantity of air: thus Hertwich perceived a
whizzing sound when air got into an open vein; and in a case of va-
ricose aneurism in the arm, where, by means of pressure, the artery
and the vein could be emptied of blood, Schottin, during the re-ad-
mission of the blood, heard a noise which, according to his account,
was comparatively duller, stronger, and deeper in the arteries, and
higher and clearer in the veins. Kennedy has lately demonstrated
by numerous observations, that the sound heard in the abdomen of
a pregnant woman, corresponding with her pulse, and differing from
that of the foetal heart, is actually produced in the maternal placenta,
as was maintained by Kergeradec : now, as this sound is heard only
during pregnancy, and that at the spot where the foetal portion of
the placenta is situated, we may reasonably suppose that this respi-
ratory organ of the foetus receives air that has been evolved in the
vessels of the membranes and of the maternal placenta. But to pro-
ceed, if the sound in the heart is produced by the rushing of the
blood into a cavity containing air, it must originate in the ventricles
and the origins of the arterial trunks, as these are the only parts of
the vascular system which-are alternately empty and full, and con-
tain both air and blood. Accordingly, we may conclude, that the
first sound is produced simultaneously with the systole of the auri-
Scientific Intelligence. 147
cles, by the rushing of the blood into the ventricles, where it meets
with air, and forces it, before the valves have entirely closed the pas-
sage, into the origin of the arterial trunks, now partly empty in con-
sequence of the advance of the blood; and further, that the second
sound proceeds from the ‘rushing of the blood into the arteries from
the systole of the ventricles, and the consequent driving of the air
there collected back again into the ventricles, now beginning to di-
late anew. This conclusion is confirmed by the following facts.
The rhythm of the sounds corresponds perfectly to that of the systole
of the auricles and ventricles: to the first sound, which corresponds
to the contraction of the former immediately succeeds the second,
answering to that of the latter, and then a pause ensues, which
marks the diastole. Laennec’s explanation, therefore, is at variance
with the most indubitable observation, and accordingly Turner and
Williams supposed, that the systole of the auricles was heard at the
same time with that of the ventricles. The first sound is heard at
the very moment when the ear, applied to the chest, receives a push
from the impulse of the heart against the ribs; and as this impulse
proceeds solely from the systole of the auricles, the sound must arise
from the same cause. When I applied my ear to the chest of a
horse, while an assistant examined the pulse of the carotid just above
the sternum, or that of the maxillary artery, on the inner surface of
the jaw, and marked it by a well defined noise, I found that the se-
cond sound was synchronous with the arterial pulse, or rather, as
Corrigan remarked, followed immediately after it. Should the latter
be the normal form, the second sound must be caused by the meet-
ing of the air that has been driven back from the arterial trunks
into the ventricles, with the blood rushing into them out of the auri-
cles. Stokes, in some experiments on rabbits, in which he had
laid open half of the cavity of the thorax, found that the systole of
the auricles was simultaneous with the first sound, and that of the
ventricles with the second..—Burdach’s Physiologie.
Extracts from the Life of Caspar Hauser.—Besides his extra-
ordinary equestrian talents, this extreme peculiarity, the almost pre-
ternatural acuteness and intensity of his sensual perceptions, ap-
peared particularly remarkable in Caspar Hauser, during his abode
in Professor Daumer’s house.
As to his sight, there existed, in respect to him, no twilight, no
night, no darkness. This was first noticed by remarking, that at
night he stepped every where with the greatest confidence, and that,
in dark places he always refused a light when it was offered to him.
He often looked with astonishment, or laughed, at persons who, in
dark places for instance, when entering a house, or walking on a
staircase by night, sought safety in groping their way, or in laying
hold on adjacent objects. In twilight, he even saw much better than
in broad daylight. Thus, after sunset, he once read the number of
a house at a distance of 180 paces, which, in daylight, he would
not have been able to distinguish so far off. Towards the close of
148 Scientific Intelligence.
twilight, he once pointed out to his instructor a gnat that was hang-
ing in a very distant spider’s web. At a distance of certainly not
less than sixty paces, he could distinguish the single berries, in a
cluster of elder berries, from each other, and these berries from
black currants. It has been proved by experiments carefully made,
that in a perfectly dark night, he could distinguish different dark
colours, such as biue and green from each other.
When at the commencement of twilight, a common eye could
not distinguish more than three or four stars in the sky, he could
already discern the different groups of stars, and he could distinguish
the different single stars of which they were composed from each
other, according to their magnitudes, and the peculiarities of their
coloured light.
From the enclosure of the eastle at Nuremberg, he could count
a row of windows in the castle of Marlofistein, and from the castle,
a row of the windows of a house, lying below the fortress of Rethen-
berg. His sight was as sharp in distinguishing objects near, as it
was penetrating in discerning them at a distance. In dissecting
plants, he noticed subtile distinctions and delicate particles, which
had entirely escaped the observation of others.
Scarcely less sharp and penetrating than his sight was his hear-
ing. When taking a walk in the fields, he once heard ata com-
paratively great distance, the footsteps of several persons, and
he could distinguish these persons from each other by their walk.
He had once an opportunity of comparing the acuteness of his hear-
ing, with the stil! greater acuteness of hearing evinced by a blind
man, who could distinguish even the most gentle stepof a man walk-
ing barefoot. On this occasion he observed, that his hearing had
formerly been much more acute; but that its acuteness had been
considerably diminished since he had began to eat meat; so that he
could no longer distinguish sounds with so great a nicety as that
blind man. : !
Of all his sense, that which was the most troublesome, which
occasioned him the most painful feelings, and which made his life
in the world more disagreeable to him than any other, was the sense
of smelling. What to us is entirely scentless, was not so to him.
The most delicate and delightful odours of flowers, for instance the
rose, were perceived by him as insupportable stenches, which pain-
fully affected his nerves.
What announces itself by its smell to others, only when very
near, was scented by him at a very considerable distance. Except-
ing the smell of bread, of fennel, of anise, and of carraway, to which
he says, he had already been accustomed in his prison, for his bread
was seasoned with these condiments, all kinds of smells were more or
less disagreeable to him. When he was once asked, which of all
other smells was most agreeable to him? He answered, ‘‘ none at
all.” His walks and rides were often rendered very unpieasant by
leading him near to flower gardens, tobacco fields, nut trees, and
other plants, which affected his olfactory nerves; and he paid dearly
Scientric Intelligence. 149
for his recreations in the free air, by suffering afterwards from head-
achs, cold sweats, and attacks of fever. He smelt tobacco, when
in blossom in the fields, at the distance of fifty paces, and at more
than one hundred paces, when it was hung up in bundles to dry, as
is commonly the case about the houses in the villages near Nurem-
berg. He could distinguish apple, pear, and plum trees from each
other at a considerable distance by the smell of their leaves. The
different colouring materials used in the painting of walls and furni-
ture, and in the dying of clothes, &c., the pigments with which he
coloured his pictures, the ink or pencil with which he wrote, all
things about him, wafted odours to his nostrils which were unplea-
sant and painfultohim. If achimney-sweeper walked in the streets,
though at the distance of several paces from him, he turned his face,
shuddering from the smell. The smell of an cld cheese made him
feel unwell, and affected him with vomiting. The smell of strong
vinegar, though fully a yard distant from him, operated so power-
fully upon the nerves of his sight and smell, as to bring the water
into his eyes. When a glass of wine was filled at table, at a con-
siderable distance from him, he complained of its disagreeable smell,
and cf a sensation of heat in his head. The opening of a bottle of
champaigne was sure to drive him from the table, or to make him
sick. What we call unpleasant smells, were perceived by him with
much less aversion, than many of our perfumes. The smell of fresh
meat was to him the most horrible of all smells.
When Professor Daumer, in the autumn of 1828,walked with
Casparnear to St. John’s church-yard, in the vicinity of Nuremberg,
the smell of the dead bodies, of which the professor had not the
slightest perception, affected him so powerfully, that he was imme-
diately seized with an ague, and began to shudder; the ague was soon
succeeeded by a feverish heat, which at length broke out into a violent
perspiration, by which his linen was thoroughly wet. He afterwards
said, that he had never before experienced so great a heat. When
on his return, he came near to the city-gate, he said that he felt
better; yet he complained that his sight had been obscured thereby.
Similar effects were once experienced by him (on the 28th of Septem-
ber, 1828,) when he had been for a considerable time walking by the
side of a tobacco field.
Magnetic and electric Bicndvents —When Professor Daumer
held the north pole towards him, Caspar put his hand to the pit of his
stomach, and, drawing his waistcoat in an outward direction, said that
it drew him thus ; and that a current of air seemed to proceed from
him. The south pole affected him less powerfully ; and he said that
it blew upon him. Professor Daumer and Professor Herrmann made
afterwards, several other experiments similar to these, and cal-
culated to deceive him; but his feelings always told him very cor-
rectly, even though the magnet was held at a considerable distance
from him, whether the north ‘pole or the south pole was held towards
him. Such experiments could not be continued long, because the
150 Scientific Intelligence.
perspiration soon appeared on his forehead, and he began to feel
unwell.
In respect to his sensibility of the presence of other metals, and
his ability to distinguish them from each other by his feelings alone,
Professor Daumer has selected a great number of facts, from which
I shall select only a few. | | |
In autumn, 1828, he once accidentally went into a shop filled with
hardware, particularly with brass goods. He had scarcely entered,
before he hurried out again, being affected with a violent shuddering,
and saying that he felt a drawing in his whole body in all directions.
A stranger who visited him, once slipped a piece of gold of the size
of a kreutzer into his hand, without Caspar’s being able to see it; he
said immediately that he felt gold in his hand. Ata time when
Caspar was absent, Professor Daumer placed a gold ring, a steel and
brass compass, and a silver drawing pen, under some paper, so that it
was impossible for him to see what was concealed under it. Daumer
directed him to move his finger over the paper without touching it ;
he did so, and by the difference of the sensation and strength of the
attraction which these different metals caused him to feel at the points
of his fingers, he accurately distinguished them all from each other,
according to their respective matter and form. Once, when the
physician, Dr. Osterhausen, and the royal crown-fiscal, Brunner,
from Munich, happened to be present, M. Daumer led Caspar, in
order to try him, to a table covered with an oil-cloth, upon which lay
a sheet of paper, and desired him to say whether any metal was under
it. He moved his finger over it, and then said, ‘‘There it draws!”
‘« But, this time,” replied Daumer, “‘ you are, nevertheless, mistaken ;
for (withdrawing the paper) nothing lies under it.” Caspar seemed,
at first, to be somewhat embarrassed; but he put his finger again to
the place where he thought he had felt the drawing, and assured them
repeatedly, that he there felt a drawing. The oil-cloth was then re-
moved, a stricter search was made, and a needle was actually found
there. He described the feeling which minerals occasioned him, as
a kind of drawing sensation which passed over him, accompanied, at
the same time, witha chill which ascended, accordingly as the objects
were different, more or less up the arm; and which was also attended
with other distinctive sensations. At the same time, the veins of the
hand which had been exposed to the metallic excitation, were visibly
swollen. Towards the end of December,1828, when the morbid ex-
citability of his nerves had been almost removed, his sensibility of the
influence of metallic excitatives began gradually to disappear, and was
at length totally lost. Animal magnetism manifested itself in him
in a manner equally surprising ; and he retained his receptitivity of it
fora much longer time then he did that of metallic excitements.
But as the phenomena which appeared in Caspar, agree in all their
essential characteristics with similar appearances in other well known
cases, it would be superfluous to add any other observations respecting
them, than that he always called his sensation of the streaming in
Scientific Intelligence. 151
upon him of the magnetic fluid, a blowing upon him. He experienc-
ed such magnetic sensations, not only when in contact with men,
when they touched him with their hand, or when they, even at some
distance, extended the points of their fingers towards him, &c., but
also when he was in contact with animals.
When he laid his hand upon a horse, a cold sensation, as he said,
went up his arm; and when he was mounted, he felt as if a draught
of wind passed through his body; but these sensations went off after
he had several times rode his horse around the riding school.
The Placenta probably a Gland, from Dr. Graves’ Lecture on the
Lymphatic System.—Fohman has proved that the lacteals always ter-
minate in a cul de suc; and therefore that they absorb through the
membranes which form their parietes. Miller, whose splendid work
on the structure of glands I have analyzed in the first number of the
Dublin Journal of Medicine, shews that the ultimate ramifications
of all ducts terminate in cul de sacs. From this it follows that no
direct communication exists between the vessels which secrete and
the ducts which receive the secreted fluids. It is probable, therefore,
that the maternal vessels and those of the foetus may carry on an
active interchange of principles, although no direct communication
by openings or mouths exists between them. The vessels of the
mother may carry principles necessary for the nutrition and respira-
tion of the foetus, and may freely impart them to its vascular sys-
tem, while, on the other hand, every thing which requires to be
excreted from the foetal system, may, in like manner, as easily find
its way into the maternal veins, and so be gotten rid of. J cannot
help thinking that ths view of the placenta, which, by comparing
the relation between the ultimate ramifications of the maternal
and foetal vessels with those of the,secreting vessels and ducts in
glands, points out not. merely the analogy, but almost the identity
of this relation, deserves the attentive consideration of physiolo-
gists. It tsto Miller that we are indebted for understanding
the analogy which the lungs bear in their structure to glands ; and
his researches first suggested to me the idea, that the placenta
may be considered as a temporary gland, destened for the nutri-
teon and respiration of the fetus.
PATHOLOGY AND THERAPEUTICS.
Luxation of the Pubis in Labour, by Dr. Riecke.—A strong
woman, 23 years old, pregnant of her first child, had a very painful
labour ; the child died during delivery. The last pain was so vio-
lent, that the woman was lifted up convulsively from the seat where
she was to be delivered, but was retained there by assistants. Nine
152 Scientific Intelligence.
days after delivery, Dr. Riecke seeing the patient for the first time,
discovered a luxation of the pubis; the symphysis was broken, and
the left pubis was carried behind that of the right side to the extent of
half an inch at least. The external parts of generation were very much
swollen, still the lochia and urine passed off freely : the patient com-
plained of pain in the region of the symphysis, and she was wholly
unable to walk, stand up, or sit down. The patient being made to
lie on her back, Dr. Riecke applied his hands to the crests of the
two ilia, pushing them back, endeavoured to separate them from each
other as much as possible, for the purpose of restoring the natural
situation of the pubis; but in consequence of the violent pain which
this attempt caused the patient he was obliged to discontinue.
However the same process, after several attempts, succeeded at
length in the morning of the second day, whilst the patient held the
legs strongly bent on the thighs. ‘The moment the luxation was re-
duced, the patient was able to walk ; to remedy the vacillating walk,
and to strengthen the articulation, she was directed to wear for
some time a bandage similar to those used in hernia. An examina-
tion of the pelvis shewed that the descending rami of the pubis
formed an acute angle, a circumstance which narrowed the lower
aperture.—Heidelberger Klinasche Annalen, t. vii. 3° cah, 1831.
Opium in Phthisis.—Dr. Berndt, Professor of Midwifery at
Greifswald, on the Baltic, while treating a young man for phthisis,
in the course of which he had to administer large doses of opium,
remarked that his patient, after expectorating a good deal of pus,
and suffering under profuse sweats and colliquative diarrhoea, not
only enjoyed quieter nights, but also felt his strength increasing, and
eradually recovered. This induced him to try large doses of opium,
to the extent of 120 drops of a tincture of the strength of a grain in
every seven drops, three or four times a day, beginning with a few
drops. In the last stages of phthisis purulenta, he combines acetate
of lead with the opium, beginning in like manner with small doses,
such as a quarter of a grain, and proceeding by degrees to very
large ones. ‘The most severe symptoms are alleviated by this treat-
ment, although abundant purulent sputa had been expectorated daily.
Cholera among the Insane.—At the Sitting of the Royal
Academy of Medicine, 3d September, M. Ferrus read the com-
mencement of a memoir of the progress and the effects of cholera in
the hospital of Bicétre, and on the ravages which it produced among
the insane: The result was, contrary to the general opinion re-
ceived, that the insane are subject like other men to epidemic in-
fluences; that. the security which they enjoy does not diminish for
them its severity, and that it is quite as necessary for their preser-
vation, to withdraw from them the causes which deteriorate the or-
ganization.
"M. Villermé disputed some propositions advanced by M. Ferrus,
with regard to the progress of epidemics which travel, and which,
Scientific Intelligence. 153
according to M. Ferrus, generally proceed from east to west; with
regard to the nourishment of the prisoners of Bicétre, which is su-
perior to that of the poor; and lastly, with regard to the danger of
cholera being in general greater to the two extreme ages, than for
the middle, as the slight loss of the veterans at the hospital particu-
larly proved, who only lost one man out of 160.
Sitting of the 10th. Fetus found in the abdomen of a female
aged78. J. M. Cloquet gave to the academy for M. Mojon, the
communication of a singular fact. It is of a foetus of three months,
found in the abdomen of a woman 78 years of age, in the centre of
a cartilaginous tumour, which occupied the right side of the true
pelvis, and adhered to the bladder, vagina, and womb, by very strong
cellular tissue. This is an instance of extra-uterine peritoneal pree-
nancy. M. Breschet observed, that facts of this nature are very rare,
and until now considered as very doubtful.
M. J. Cloquet answered, they had been well authenticated in
animals: such encysted tumours have been seen in cats, which
contained foetuses fully developed, and which had no adhesion but to
the peritoneum. In women, it is true, these facts are rarer and
more difficult to authenticate.
_ M. Velpeau, on the contrary, believes that there are very posi-
tive examples. He quoted two examples, where the foetuses had no
connexion either to the ovaries, fallopian tubes, or uterus. M. Vil-
peau particularly quoted a woman at Port-a-Mousson.
M. Breschet contended, that having had occasion to examine that
question in concert with M. Beclard, and the facts being scrupu-
lously examined, they both considered these facts not well authenti-
cated, and that they could come to no certain conclusion.
M. Capuron said, he and M. Lisfranc saw a-case which they
believed to be reversion of the uterus. The woman died, and upon
examination a large tumour presented itself, which contained a foetus
seven months old.
M. Lisfranc added, that the envelope was homogeneous, and hard
like cartilage. The observation was, at the time, (in 1823 or 1824.)
communicated to the academy. ,
M. Deneux advanced, that pregnancies of that nature seldom
arrived at the accustomed period, as to the rest, error in such cases
is very easy. Being at Naples, he saw a female opened, who, ac-
cording to the persons present, had peritoneal pregnancy. That
pregnancy was in the fallopian tube, but we must not be astonished
at their having published it a case of peritoneal.
M. Velpeau again rose, to recal a fact which M. Esquirol had
seen, and which was analogous to the one reported by M. Mojon.
M. Esquirol affirmed to that effect, that at Salpétriére, a tumour
was found in the abdomen of a women 68 years of age, analogous to
the one in question, and which was entirely independent of the geni-
tal organs.
M. Moreau agreed both with M. J. Cloquet and M. Breschet. In
woman there is often confusion on that point. Latterly he again
VOL. V. No. 13. x
154 Scientific Intelligence.
saw at the Maternité, in the abdomen of a woman, a foetus with its
face towards the diaphragm, and which contained a kind of secon-
dary cyst, or a false membrane, which was spread through the whole
intestinal canal; but the umbilical cord was attached to a placenta
incorporated with the ovary. In animals, these kind of facts are
often observed; a she rabbit, some years back, contained a certain
number of feetuses, floating and detached in the abdomen.
M. Lisfranc contended, that this phenomenon is as constant in
woman.
Hemorrhage from between the Placenta and the Chorion ; Abor-
jion at seven Months, by Messrs. Grisolle and Caseaux.—Rocques-
Marie-Joseph Herce, aged 29, pregnant for the fifth time, was seven
months gone, and for nearly the last four months has lost a certain
quantity of blood daily, by the vulva. These continual hemorrhages,
which increased towards the sixth month of gestation, had so re-
duced the young woman, naturally strong, although a little of a lym-
phatic temperament, that she has become pale and yellowish, as if
chlorotic—_she has severe palpitations, is not able to work, and has
syncope frequently during the day.
“ The 5th of May, at five o’clock in the evening, the uterine
hemorrhage became more abundant, at the same time, dull inward
pains, the situation of which seemed to be in the uterus, indicated an
;mmediate abortion. The midwife who was called believed she felt
the placenta at the neck of the uterus; alarmed at that circumstance
she conveyed the patient to the Hotel Dieu, where we found that the
soft and effaced neck of the uterus, was dilated to the size of a five
franc piece; the slight distention of the membranes allowed us to de-
termine a first position of the head. We could not feel any soft body
either at the neck of the uterus, or in the neighbouring parts. All
hemorrhage having ceased, and her pulse being sufficiently strong, we
left her. The pains which had almost ceased, soon returned, and at
four o’clock in the morning she was delivered of a seven months
child. In its passage the foetus brought away with it the cord and a
membranous mass, which one of us believed to be one of those mem-
branous placentee described by authors. Immediately afterwards,
five or six clots of blood about the size of one’s fist followed. The
foetus was dead, and life appeared extinct only a few seconds. The
skin was not oily (circuse), the internal organs still contained blood ;
but for all this we believe it died of hemorrhage ; M. Orfila having
proved, that when the foetus dies of hemorrhage, there is not an abso-
lute vacuum of the vessels, nor discoloration of the viscera and mus-
cles, as was believed. During the following night the woman ex-
pelled some more clots rather less than the former, together with a
placenta of ordinary size. Its uterine surface was smooth, and quite
in its natural state: the foetal surface, on the contrary, was covered
with clots of blood nearly. half an inch thick. The placental vessels
were completely ruptured at about half an inch or an inch from the sur-
Scientific Intelligence. 65
face. The other extremities of the divided vessels could be observed
at the placental surface of the membranes: they were either open or
obstructed by clots of fibrin newly formed. The principal divisions
were in their natural state permeable to the blood. The woman ex-
perienced no accident, and of her own accord quitted the hospital six
and thirty hours after delivery.
The preceding case appears to us very interesting, and we have
not been able to find an analogous one in the best works on midwifery.
Vaccination, Cowpox.— Academy of Medicine, sitting of the Ist
October. M. Fiard states, Ist, the opinion of Jenner, who conceives
that the cowpox is given to the cow by the fluid found in the legs of
the horse: 2nd, the opinion of M. Robert, who believes that the cow-
pox is the smallpox passed from man to the cow, and taking, when
transferred to that animal, the particular form by which it is dis-
tinguished ; 3rd, the opinion according to which persons consider
cowpox as proper to the cow, in the same way as smallpox is proper
to the human being. Aiter which M. Fiard gives an account. of
some experiments made by himself to illustrate these three ques-
tions,
He inoculated cows: Ist, with the virus extracted from the lees
of the horse; 2nd, with the virus of smallpox—nothing resulted
from these experiments. M. Fiard was not able to repeat the expe-
riment made in England by Sunderland. He believes that cows are
often subject to a disease very much resembling cowpox, and which
is still not the same disease.
To prove which, M. Girardin referred to the experiments by
which Dr. Sunderland alleges that he inoculated cows with cowpox,
by enveloping them with a cover containing the miasma of smallpox.
Suppose the experiment efficacious, it gives us the means of remov-
ing cowpox, and proves that smallpox preceded it. The Academy
had some idea of renewing the experiment, but were not able to pro-
ceed for want of funds. M. Girard has proposed to renew them at
Alfort. The 15th of September last, bed-clothes which had been
used by persons labouring under smallpox, were furnished by M.
Piedagnel, and sent to Alfort by M. Girardin, They were carried
for several days by cows without any result. In England, and in
Italy, the same attempts have been made, and without happier re-
sults. M. Girard intends to recommence these experiments at Ram-
bouillet.
M. Bosquet adds, that a lady of the department of Tarn renewed
the experiment, and did not succeed.
M. Husard remarked, that the first vaccine committee had made
the same experiments at Paris and Rambouillet with vaccine matter.
The result was also negative.
M. Husson believes that the memoir of M. Husard is defective
here. M. Boiveau Laffecteur, sen., had himself inoculated, but be
insisted that the vaccine should be taken directly from a cow. He
156 Scientific Intelligence.
had several cows at his house in Mouffetard-street. M. Husson
vaccinated some of them—vaccination took, and served to vaccinate
with success both his child and M. Boiveau Laffecteur himself, who
had vesicles only on one arm. That experiment has been repeated
on the cow without success.
Congenital Exstrophy of the Bladder, by M. Velpeau.—In the
memoirs of the Royal Academy of Medicine, there appears a very inte-
resting paper, by M. Velpeau, on the above defect of conformation.
M. Velpeau was commissioned by the Academy to examine an ac-
count of a case, submitted to them by Dr. Mallet, of a child six days
old, born at the regular term, on whom there was observed a tumour
of the size of an egg, of a reddish colour, situated in the hypogas-
trium below the umbilicus. Inferiorly this tumour was continued in
the form of a gutter over an appendage, which presented itself in
front of the pubic region. Irreducible, pliant, and of a fungous ap-
pearance, it presented four nipples, from two of which there exuded
a clear liquor, which had all the characters of urine. In other
respects the child was perfectly healthy and strong.
This he designates by the name of exstrophy, or extroversion of
the bladder. The red tumour he considers to be the posterior paries
of the bladder. The inferior nipples enclose the orifice of the ure-
ters. The appendix and groove below represent the penis cleft in its
dorsal aspect, and presenting posteriorly two apertures, which were
taken for the entrance of the seminal ducts. A considerable num-
ber of cases with this defect have been recorded by medical writers ;
the female sex, it is admitted, is not exempt from it, at the same time
that the inconveniences are not near as distressing as to males for
obvious reasons. With respect to the anatomical varieties accom-
panying this defect, cases are recorded where both the anus and penis
were wanting. In a considerable number there was no umbilicus ; in
other cases, though the navel exists, it is found situated much lower
than usual. Separation of the pubis is another coincidence, and one
also which has been mentioned by Baillie in his Morbid Anatomy.
With respect to the nature of this defect, it was for a long time con-
sidered as the result of a hernia, of reversion of the bladder. The
incorrectness of this opinion was however clearly established by Te-
non some years back. He saw that the bladder was destroyed in all
its anterior part, and that the tumour which presents is the posterior
half of this viscus pushed forward by the abdominal viscera, as if to
make up for the loss of substance which the sub-umbilical region
seems to have undergone. Various explanations have been given to
account for this defect. Dr. Duncan in the Edinburgh Journal at-
tempts to shew, that an obstacle to the expulsion of urine satisfac-
torily accounts for it. Others insist on a@ primitive monstrosity in
the case. The greatest number explain the phenomenon by the hy-
pothesis of arrest of development.
If hypothesis be at all necessary, M. Velpeau prefers considering
that the defect depends on an alteration, either pathological, or
Scientific Lntelligence. 157
purely physical, of the lower part of the abdomen, contracted during
embryonic life. It is there that the parietes of the abdomen are
longest in closing. They there remain thin and very delicate, even
up to two or three months. At a later period still they acquire not
the same density nor tenacity as they possess above the cord. At
first this is separated from the sexual organs by so small a space, that
the least cleft may become the origin of a large ulceration. Hence,
then M. Velpeau concludes, that exstrophy of the bladder is a disease,
or the effect of a disease, and not a monstrosity, An ulceration, a
perforation of the penis or hypogastrium, is its ordinary commence-
ment. The alteration of the bladder is but secondary. If the foetus
continues to live, and that abortion does not come on, or if the ovum
is not transformed into a mole, the edges of the bladder so destroyed
unite to the circumference of the hole in the abdomen, or to the pos-
terior edge of what remains of the hypogastrium. Cicatrization
being effected, the remainder is at once explained by the mucous na-
ture of the organic substance which occupies the place of the pelvic or
abdominal parietes. Thus it is conceived, that the umbilicus may or
may not be included in the loss of substance; that the bones of the
pubis which are destroyed in such cases, and not merely separated,
as is thought, may also be sometimes preserved ; lastly, that the vesi-
cal tumour may occupy but the space of a few lines in some cases,
and in others include a considerable portion of the hypogastrium.
SURGERY.
Torsion of the Arteries, practised with success in amputation of
the leg, at the general hospital of marines at Alexandria, in Egypt,
the 26th July, 1833, by Dr. Clot-Bey.—The 26th July, 1833, Dr.
Grassi, in the general hospital of marines, amputated the left leg for
a case of comminuted fracture, of an Arab sailor. I proposed to the
operator the twisting of the arteries, and he requested me to proceed,
not knowing himself how to execute that new method. Then witha
common forceps, I seized successively the extremities of the anterior
and the posterior tibial, the only bleeding arteries; and in drawing
them towards me, I placed the thumb and index finger of the left hand
above the points of the forceps; I turned them four or five times on
their axis ; afterwards I loosened the vessel, and pushed it slightly
into the tissues. The stump was left uncovered a few minutes, and I
convinced myself that the mode employed had entirely stopped the he-
morrhage ; but howeverI was not quite secure. The wound was covered
and dressed, and I then applied a tourniquet, and confided it to the
care of a student, so that in case of hemorrhage he might immediately
stop it, It is now fourteen days since the operation, and the wound is
nearly cicatrized, without any manifestation of the least flow of blood.
153 Scientific Intetligence.
This is one of the first cases in which the twisting of arteries has
been employed in man. It is not sufficient for us to conclude in
favour of that method, but it will serve at least to encourage practi-
tioners to try it.
It was during my last sojourn at Paris, in following the experi-
ments of Dr. Amussat, that I understood the advantages which would
ensue from the twisting of arteries: it is to the complaisance of that
zealous and learned investigator that I am also indebted for having
enlightened me on other important points of the science.—evue
Med. Noy. 1833.
Lisfranec’s Views regarding Superfical Cancer.—The recent
progress of pathological ‘anatomy has’ shewn, that cancerous afiec-
tions do not simultaneously invade all the tissues of the organ in
which they are developed: thus, for example, in cancers of the
stomach, the disease is sometimes limited to the muscular coat, some-
times to the cellular layer uniting it to the mucous membrane; and
even when all these membranes are affected by the disease, careful
dissection enables us to distinguish the tissue primarily attacked.
This regular succession in the progress of cancer had for a long
time engaged my attention; in the cases of women in my hospital,
whose breasts were affected with inveterate cancers, I had satisfied
myself that the disease had been arrested for years by the pleura,
which continued entirely free in the midst of the surrounding disease.
I had repeatedly observed the same thing in a great number of
very old women, who were brought from the Salpetriere into the
amphitheatre, as subjects for my lectures on operative surgery: in
three subjects who had died of carcinoma in the umbilicus of very
long standing, I had ascertained that the peritoneum, in the abdo-
men, opposed the same barrier to the advance of cancer, as the pleura
did in the chest; finally, I had a slight recollection of having
several times dissected in my youth, the penis which had been ampu-
tated for cancerous affections, in which I discovered that the corpus
cavernosum was perfectly sound, notwithstanding the destruction of
the other tissues constituting this organ.
On considering these facts, I conceived the possibility of con-
verting to the benefit of surgery data so positive, furnished by patho-
logical anatomy. When an organ is cancerous, may we not hope
that the disease will be thus limited in its progress, especially if there
enters into its structure an organic layer adapted to its insulation ?
And if such be the case, instead of sacrificing the entire organ, as
usually directed, may we not hope to preserve it, by removing only
the part really diseased? Would not such be the real end of surgery
which is to preserve, not to destroy ?—Mem. Acad. Roy. Med., tom.
trois,
These views of M. Lisfranc’s are illustrated by some highly impor-
tant cases. —Ep.
THE
DUBLIN JOURNAL
OF
MEDICAL AND CHEMICAL SCIENCE.
I MAY, 1834.
PART I.
ORIGINAL COMMUNICATIONS.
Art. XIL—On the Use of Mercury in Ulceration of the Car-
tilages of Joints. By James O’Burrne, M. D., Surgeon
Extraordinary to the King, one of the Surgeons of the Rich-
mond Surgical Hospital, House of Industry, Dublin, &c.
&C.
(Read at the Surgical Society of Ireland, March 8th, 1834.)
Every experienced surgeon must have felt, that all the means
which have been hitherto employed to subdue this destructive
and excruciating affection of the joints, fail but too frequently
in saving life or limb ; and that they act always too slowly, and
seldom so decidedly as to completely remove the disease, and
secure the patient from a relapse. Hence it is, that Cru-
veilhier declares, that he knows no means of curing this ulcera-
tion, supplying the destroyed cartilages, and favouring their re-
production; and yet, that nature every day covers with new
cartilages, or with new osseous vegetations, the surlaces of
bones which were not destined to rub against each other.*
* Je ne connais aucum moyen de remédier a cette usure, de suppléer aux car-
tilages détruits, de favoriser leur reproduction, et cependant tous les jours la na-
VOL. Vv. No. 14, ¥
160 Dr. O’Beirne on the Use of Mercury in
Hence it is, also, that Mr. Brodie, in many parts of his invalu-
able work on diseases of the joints, is found expressing nearly
similar opinions. Speaking of synovitis terminating in ulcera-
tion, he says, “no method with which I am acquainted, is ca-
pable of doing more than somewhat checking the progress, and
somewhat relieving the symptoms of the complaint,” p. 108,
Qnd ed. Again, treating of ulceration of the cartilages as a
primary affection, he states, that he is not “acquainted with
any medicine which can be said to exercise a specific influence
over this complaint,”’—p. 177. It is manifest, therefore, that
there are these all-important defects in our means of com-
bating the disorganizing process, and the suffering which at-
tend such cases. With a view to their removal, the subject has
long occupied my attention; but how far I have succeeded re-
mains to be shown, and to be determined by further expe-
rience.
Mercury, from its decided and happy effects in all kinds of
membranous inflammation, always appeared to me to be the
only agent capable of answering the various ends in view. But
the injurious consequences so generally said to attend its use in
scrofulous persons, who are so frequently the subjects of this
affection of joints, deterred me for a long time from giving it a
trial. The following considerations, however, could scarcely
fail to have great weight. In the first place, it must be ad-
mitted, that injurious consequences have not always attended
the use of mercury in strumous persons, and as far as my expe-
rience has led me to observe, they have supervened chiefly in
cases where ptyalism has been produced slowly, or only in a
slight degree. Secondly, we are not without means of antici-
pating and preventing the supervention of such consequences, or
of combating them when they have supervened. Thirdly, in
ie AAS OT) es) vo ee ee
ture couvre de cartilages nouveaux des surfaces osseuses, qui n’ étaient point des-
tinées a frotter les unes contre les autres, ou des végétations osseuses nouvelles.—
Dictionnaire de Médecine et de Chirurgie Pratiques, t. uli. p. 509, art. Articula-
tions, (Maladies Des.)
Ulceration of the Cartilages of Joints. 161
cases of syphilitic iritis occurring in scrofulous persons, we do
not hesitate to use mercury, so as to produce ptyalism as rapidly
as possible, in order to save the eye; and yet, we rarely ob-
serve serious consequences to attend the practice. Fourthly,
it is manifest that there is much greater danger in permitting
such a disorganizing process to go on unchecked in the carti-
lages of jomts, than from any of the ordinary consequences of
the free use of mercury in strumous habits. Ultimately, these
considerations prevailed, and decided me on giving this agent a
trial in cases of the description under consideration; and to
employ it so as to act rapidly and fully on the mouth. The
first trial was made, about a year ago, in the case of a woman
admitted into the Richmond Surgical Hospital, with ulceration
of the cartilages of the knee joint. In this case, the value of
the mercurial plan of treatment seemed to be established by
the disappearance of all the symptoms, as soon as the mouth
became affected; and by the fact of the woman regaining the
full power of walking, and being discharged perfectly well, in
the course of a fortnight from her admission. Since that time,
{ have tried the same plan in similar affections of the joints,
and with similar results. Three of my colleagues in the Rich-
mond Surgical Hospital, and Mr. Cusack Roney, one of the se-
nior surgeons of the Meath Hospital, have also employed it
with success; and I shall now detail some of the cases which
have been treated by myself and these gentlemen, on the mer-
curial plan.
WRIST JOINT.
Case [.—James Carroll, aged 21, of delicate make, and
pale, strumous countenance, admitted on the 21st of Septem-
ber, 1833, mto the Richmond Surgical Hospital, under my
care. He makes the following statement :—about four months
ago, he received a blow on the right wrist, which produced pain
and swelling of the joint. These were removed in the course
of four weeks by stupes, poultices, and blisters. Six weeks
162 Dr. O’Beirne on the Use of Mercury in
after, he got a fall, by which, the wrist joint was violently
flexed, and immediately became painful, and soon after swelled.
Leeches, cold lotions, fomentations, succeeded by blisters, and
a variety of other stimulating applications, were employed by
several medical gentlemen, under whose care he had been, but
without any benefit. His state, on admission into this Hospi-
tal, is as follows: the right wrist jomt is considerably swelled,
and evidently contains a fluid. The hand, when unsupported,
hangs down, and the ligaments of the joint being greatly relaxed,
it may be moved much more freely than usual, and in almost every
direction. On pressing the hand upwards, so as to bring the
articular surfaces of the wrist into contact, excessive pain is felt
im the joint; but on making extension from the hand, so as to
separate these surfaces, he says, that he is relieved from pain,
which is otherwise constant and severe, but so much more so at
night, that he searcely enjoys any sleep. The skin of the back
of the hand approaches to a livid colour. His pulse is quick,
and the tongue covered with a whitish fur. The bowels are
rather regular.
On his admission leeches were applied to the wrist. After-
wards blisters were repeatedly placed on the joint, and dressed
with strong mercurial ointment. Subsequently, frictions with
liniment of olive oil and sulphuric acid were used ; iodine lo-
tions, and lotions of acetate of lead were applied ; straps of bel-
ladonna and mercurial plaster were placed round the joint, and
so as to exert considerable pressure ; and the fore-arm and
hand were constantly kept extended on a splint. The internal
remedies employed, were purgatives occasionally ; colchicum
draughts at bed time; ten drops of tincture of iodine taken
three times daily for a week ; and compound infusion of sarsa-
parilla. But all these means proved fruitless ; the wrist conti-
nued as much swelled as before, and the pain and sleeplessness
were rather increased than diminished, while the general health
and strength seemed to have suffered considerably.
Under these unpromising circumstances, I resolved on put-
Ulceration of the Cartilages of Joints. 163
ting him under the influence of mercury. Accordingly, on the
12th of October, (three weeks from his admission into the
Richmond Surgical Hospital), eighteen grains of calomel and
three grains of opium were ordered to be made into six pills,
and he was directed to take one of these every third hour.
14th. No material change. Pills repeated.
15th. Mouth becoming affected. Slept last night better
than usual; and there is now much less pain on bringing the
articular surfaces in contact. Complains of griping pains in the
bowels, which have been constipated for some days. Ordered,
a draught of castor oil, compound tincture of senna, pepper-
mint water, and mucilage.
16th. Severe griping pains ; bowels not freed; mouth some-
what more affected; has had some sleep. Ordered to have a
bolus consisting of five grains of calomel, fifteen grains of com-
pound powder of jalap, and a sufficient quantity of electuary of
senna; and if the bowels are not freed in the course of two
hours, to take a draught of infusion of roses and sulphate of
magnesia.
17th. Bowels well freed; no griping pains in the abdomen;
mouth still more affected ; general state improved.
21st. Mouth very sore. Slept soundly last night; pain re-
markably diminished, and some diminution of the swelling of
the wrist. Ordered a gargle composed of two ounces of the
solution of chloride of soda, five ounces of water, and one ounce
of simple syrup.
22nd. Ptyalism profuse. Pain and swelling of the joint
still further diminished. Inside of the mouth to be brushed
with a ten grain solution of nitrate of silver. A cold lotion to
be applied over the joint.
23rd. Great swelling, tension, pain, and redness of the hand
and inferior portion of the fore-arm, which the patient attri-
butes to the cold lotion. The hand and fore-arm to be en-
veloped in a warm emollient poultice. Cold lotion to be
omitted. Gargle to be repeated.
164 Dr. O’Beirne on the Use of Mercury in
25th. Swelling, tension, redness, and pain nearly gone.
Sleeps well at night. General health improved. The hand not
only does not fall down when unsupported; but he has even re-
gained the power of flexing and extending it tolerably well.
30th. Complains of nothing but weakness of the joint.
Discharged from Hospital ; but directed to keep the hand ex-
tended on a splint for some time, and to frequently use friction
with olive oil.
This man again presented himself at the hospital on the
3lst of last December, (two months from his discharge), with a
small fluctuating tumour situated over the centre of the third
metacarpal bone of the same hand. This tumour was opened
by a lancet, and discharged a:small quantity of scrofulous mat-
ter. Ina few days the abscess was perfectly healed; and he
was able to resume his ordinary occupations ; but the ligaments
of the wrist were still rather relaxed.
KNEE JOINT.
Case II.—James Flood, aged 23, admitted into the Rich-
mond Surgical Hospital, under my care, on the 16th of Sep-
tember, 1833. About eighteen months ago, he had a gonor-
rhea, and a swelled testicle, for which he was placed under the
influence of mercury. He afterwards caught cold, his right
knee swelled, and he was admitted into the Richmond Hospi-
tal by Dr. Peile, who succeeded in completely removing the
swelling and other symptoms. Shortly after leaving the hospi-
tal, his left knee became attacked with a dull pain, which
slowly increased in acuteness during seven or eight months, un-
til about four months ago, when it became excessively great,
and the knee began to swell. At present, except at night when
it is very severe, he has no pain when lying quietly, and in the
horizontal position; but when he moves, or attempts to stand,
or when the heel is struck ever so lightly, he immediately feels
very acute pain in the knee joint. He complains also of an
acute pain extending down the outer side of the leg, and termi-
Uiceration of the Cartilages of Joints. 165
nating at the sole of the foot. The effusion into the joint is
considerable; but there is no discoloration of the cutaneous
surface. His general health is impaired.
Frequent leeching, cupping to eighteen ounces above the
knee, blisters, lotions of acetate of lead, frictions three times a
day with strong mercurial ointment, anodyne draughts, and
draughts of camphor mixture and wine of colchicum, were em-
ployed in succession, but without any benefit, until the 28th of
September, when he was ordered to take a pill containing three
grains of calomel, and half a grain of opium, every third hour.
September 30th. Mouth not affected. No material change.
Pills repeated.
October Ist. Considerable ptyalism. Pain and swelling
greatly reduced ; and he feels comparatively little pain in mov-
ing in bed, or when the heel is struck smartly. Pills omitted.
Ordered to have a draught of vinum colchici and camphor mix-
ture at night.
October 2nd. Complains of severe griping pains in the
stomach and bowels. Ordered a purgative draught, followed
by an emollient enema; a blister to be applied to the epigas-
trium ; and when his bowels have been freely moved, to take
occasionally saline effervescing draughts, and beef tea ad ii-
bitum.
October 3rd. Slept soundly last night. Mouth still con-
siderably affected ; griping pains gone. Pain and swelling of
the knee remarkably diminished, and very little inconvenience
from striking the heel; no pain whatever in the outer side of
the leg. Enema, saline draughts, and nourishment repeated.
The knee to be covered with an emollient poultice, frequently
renewed, and as warm as he can well bear it.
In a few days, this man found that he could stand upon the
limb, and walk about without pain, but in doing so, said that
the joint and limb felt very weak. He was, therefore, confined
to bed, ordered frictions of soap liniment to the limb, and to
have full diet. Under this plan his general health recruited,
166 Dr. O’Beirne on the Use of Mercury in
and the power of the limb became so completely restored, that
he was discharged from hospital on the 26th of October, that
is, on the twenty-eighth day from the commencement of the use
of mercury.
Case Ii].—John Ashmore, aged 15, transferred from No. 1
Ward, House of Industry, to the Richmond Surgical Hospital,
and placed under my care, on the 14th of December, 1833.
His intellectual faculties are rather weak ; his stature is low for
his years; and the lumbar portion of the spinal column is ob-
served to be slightly curved towards the left side. It appears,
that about two months ago, a wheelbarrow had accidentally
fallen upon his right knee, and caused it to become consider-
ably swelled and very painful. Two blisters applied to the
joint, removed the swelling, but the pain continued, and in-
stead of being confined, as at first, to the knee, shot up the thigh
and down the side of the leg, and became of such a starting,
- lancinating kind, as to frequently awaken him from sleep. His
present state is this: the right thigh is much more rigid than
the left; the affected knee is of the same form and size as the
sound one; when in bed, striking the right heel gives him great
pain in the corresponding knee, which he is disposed to keep
in the bent position. He cannot walk without feeling great
pain in the affected joint, and in doing so, rests on the heel of
that side, with the toes turned upwards.
17th. Ordered six pills, each composed of three grains of
calomel, and half a grain of opium, and to take three of these
daily, until the mouth becomes affected.
20th. Mouth not affected. No perceptible change. To
have three pills as last ordered.
21st. Mouth slightly affected. States that he was less fre-
quently disturbed last night by pains. Pills repeated as yester-
day.
22nd. Mouth very little more affected than yesterday.
Complains of pain in the head and back. | Pulse quick, tongue
white, skin hot, thirst, bowels confined. He appears to have
Ulceration of the Cartilages of Joints. 167
caught cold, in consequence of a window close to his bed hav-
ing been left open for some hours. Ordered to take imme-
diately fifteen grains of hippo and one grain of tartarized an-
timony, and in a few hours after it has acted as an emetic, to
have a dose of infusion of roses and sulphate of magnesia, a
blister to be applied to the nape of the neck, and to be placed
on low diet.
23rd. Feverish symptoms abated. The emetic and the
purgative mixture repeated.
24th. No pain in the head or back; pulse ninety ; tongue
cleaning, bowels free, but is thirsty, and the temperature of the
skin is higher than natural. . Ordered to be given every second
hour a table-spoonful of a solution containing one grain of tar-
tarized antimony, six ounces of water, and half an ounce of sy-
rup of peppies. To have also a warm bath in the evening.
26th. All feverish symptoms have disappeared since yester-
day, and there is now scarcely any appearance of ptyalism.
Ordered to recommence the pills of calomel and opium as be-
fore, and to have middle diet.
29th. Mouth moderately affected. The starting pains are
less severe and constant in the joint; he can bear more weight
on the limb, in standing; and he says, that striking the heel
does not hurt him so much. Calomel and opium pills re-
peated.
January Ist, 1834. Greater tenderness of the gums, and fe-
tor of the breath, but little salivation. Further improvements
in all the points noticed in last report. Pills repeated.
2nd. Ptyalism fully produced. No pain whatever on strik-
ing the heel with force, or in walking or standing; but the
thigh of the affected side is still rigid, and he walks stiffly, and
on the right heel. Ordered to be confined to bed, and to have
a pint of the compound infusion of sarsaparilla daily, for some
days.
15th. Discharged ; and transferred to his ward in the
VOL. v. No. 14. 7,
168 Dr. O’Beirne on the Use of Mercury in
House of Industry, with directions to have him kept in bed, and
confined to the recumbent posture for some weeks.
On visiting and examining him this day, (March the 6th),
it appears that this boy has resolutely refused to be con-
fined to bed, or prevented from walking. He has now some
puffing about the patella ; slight pain in walking ; walks upon the
right heel; and has considerable tenderness on pressure made
over the spinous process of the second lumbar vertebra. It will
be necessary, therefore, to re-admit him into hospital, and to
direct attention not only to the knee, but also to the affection of
the spinal column.
The following case came under the care of my colleague,
Dr. Ephraim M‘Dowel, who, with his usual liberality and kind-
ness, transferred its treatment to me.
ANKLE JOINT.
Case 1V.—William Cromwell, a tailor, aged 21, and de-
cidedly of a strumous constitution, admitted into the Richmond
Surgical Hospital, on the 11th of February, 1834. He states,
that about three years ago, he first experienced a dull pain,
without any swelling, in the left ankle joint ; and that in a year
after, he could not sit with his legs crossed, as is usual with per-
sons of his trade, from severe pain in the joint. A blister, ap-
plied to the ankle, was followed by an aggravation of pain, and
the appearance of swelling. He was afterwards admitted into
the Downpatrick Infirmary, where blisters and frictions with
tartar emetic ointment were employed, but without affording
him any relief. There is now such swelling as to obliterate
the natural depressions about the ankle; he has severe pain in
the joint, increased by striking the heel; and it is so much
more severe at night, that he is frequently disturbed from sleep.
He cannot walk or bear his weight upon the limb without con-
siderable pain, and he complains of frequent startings of the
leg and thigh. His general health appears to be good. Or-
dered to be placed on low diet, and take, every third hour, a
pill, containing three grains of calomel and half'a grain of opium:
Ulceration of the Cartilages of Joints. 169
16th. After taking three pills, his mouth became slightly
affected, and soon after he became faint, vomited, and refused to
take any more pills. Ordered to take a dessert spoonful, three
times in the day, of a mixture composed of an ounce of infusion
of cinchona, and one grain of oxymuriate of mercury ; and to
rub the joint with tartar emetic ointment.
18th. Mouth affected, but not fully; pain and swelling of
the joint diminished ; starting of the limb less frequent. A few
scattered pustules about the joint, and on the inner side of
the foot; tartar emetic ointment discontinued ; mixture con-
tinued.
19th. Slept well last night. Slight salivation; feels much
less pain on striking the heel. One grain of calomel, and three
grains of aromatic powder, ordered to be taken every fourth
hour.
20th. Has slept soundly during the night. Mouth fully
affected. Pain and swelling still more diminished ; can stand
and bear upon the affected limb, and in doing so, complains
chiefly of weakness, and very little of pain in the joint. Calo-
mel pills omitted. 7
22nd. A considerable degree of salivation. Very little
pain on striking the heel, but it is felt in standing, yet much
less severely than at the time of his admission. When in bed
he moves the joint freely, and without inconvenience, which he
could not do before, and he says, that “ the joint is much more
supple and easy than it has been for a long time.”
24th. Improving. Ordered a gargle of chloride of soda.
27th. Mouth very little affected. Sits, on being directed,
in the cross-legged posture, and says, that he has far less pain
in doing so, than he had felt during the last two years. Stand-
ing still gives considerable pain in the ankle; less thickening
about the jomt. Ordered a grain of calomel and three grains
of aromatic powder, every third hour.
28th. Mouth not affected ; has been very frequently purged,
and with severe pain. Twelve grains of calomel, and two of
170 Dr. O’Beirne on the Use of Mercury in
opium, to be divided into four pills, and one of these to be taken
every fourth hour.
March Ist. Mouth very little affected ; has had no purging
or tormina. Pills of calomel and opium repeated.
2nd. Considerable ptyalism. Gargle of chloride of soda re~
peated. Pills omitted.
3rd. Mouth still much affected. Able to sit cross-legged
without any pain. Complains of slight tormina.
Sth. Very little affection of the mouth; appearance of the
joint improved ; has very little pain in standing. Can sit cross-
legged, and in this position springs up and down so as to throw
the weight of his body on the ankles, without feeling any de-
gree of pain. Thinks himself getting rapidly well. Ordered to
bestill confined to the recumbent posture ; to rub two drachms of
camphorated mercurial omtment daily, to the affected joint; to
take a pint of the compound infusion of sarsaparilla every day ;
and to be placed on full diet.
This man is still in hospital, and improving daily, but
the disease has been of such long standing, that perfect recovery
cannot be expected for some weeks.
HIP JOINT.
Caszt V.—On the 28th of November, 1833, I was requested
to see Miss Eliza O , residing at Booterstown Avenue,
near this city, aged fourteen, of an active, lively disposition, with
blue eyes, and a clear, delicate complexion. ‘This young lady’s
mother informed me, that her daughter was observed, about a
month ago, to limp about the house, apparently without pain ;
that in walking, she moved the right leg outwards, and so as to
describe a half-circle ; that about a fortnight ago, she com-
plained of a pain in the left hip, grom, and knee, which was at
first of a dull kind, but gradually became so acute, particularly
at night, that her father became alarmed, and confined her to
hed. On carefully placing her for examination, in the horizon-
tal position, the internal malleolus of the left leg is situated
Ulceration of the Cartilages of Joints. 171
lower by half an inch than that of the right; and the left heel
evidently descends lower than the right. Striking the left heel,
ever so gently, gives her great pain in the hip jomt. The
slightest pressure over the left groin, where there is some tume-
faction, or on the corresponding trochanter, also causes severe
pain in the hip joint. She complains of acute pain in the knee,
shooting along the leg to the ankle; and she cannot bear the
left ham to be pressed upon. Pressure along the course of the
sciatic nerve produces no inconvenience. When taken out of
bed, she stands with the affected knee bent and advanced ‘be-
yond the sound one; and puts only the toes of the left foot to
the ground; the left nates is flattened, flaccid, and apparently
broader than the right, and there is no vestige of the transverse
fold in which it naturally terminates. Pulse natural, general
health little impaired, bowels rather confined, tongue whitish.
This being the first opportunity that I had of treating the
disease in the hip, on the mercurial plan, I was naturally anx-
ious to give it a trial. But I considered it only fair and pru-
dent to represent all the facts of the case to the young lady’s
parents, and recommend a consultation. My representation
had the desired effect, and it was agreed to call in the able as-
sistance of my colleague, Mr. Richard Carmichael. Six leeches,
followed by cold lotions, were ordered to be applied to the
affected groin.
On the following morning she was seen, in consultation withme,
by Mr. Carmichael, who at once recognized the case as one of hip
disease, and concurred in the propriety of employing mercury, in
conjunction with other means. Ordered to take a pill consist-
ing of one grain of calomel, and two grains of aromatic powder,
three times daily, until the mouth becomes touched ; to have a
blister applied behind the left great trochanter ; and the vesi-
cated surface to be dressed with tartar emetic ointment; also, to
be confined to the horizontal position in bed, and to lie on a
firm mattress.
December 3rd. Mouth slightly affected, Says that she
172 Dr. O’Beirne on the Use of Mercury in
feels greatly relieved from pain ; but complains of the severity
of the blister ; bowels still confined. Pills to be repeated until
the mouth becomes more decidedly affected ; and if the bowels
be not moved before to-morrow morning, to have a dose of cas-
tor oil.
5th. Has taken five pills since last visit. ‘Took also a dose
of castor oil yesterday morning, which produced dark greer.
discharges from the bowels. The gums are now tender, and
the breath is fetid. There is no pain on pressure upon the
groin, or in the ham, of the affected side. She no longer com-
plains of pains in the knee or leg; the left nates is nearly as
plump and firm as the right, and the transverse fold at its lower
margin has reappeared, and is distinctly marked, but it is situat-
ed somewhat lower down than on the opposite side; and both
lower limbs are precisely of the same length. Pills omitted ;
allowed weak chicken broth.
8th. No pain whatever in the groin, knee, or ham. On
being placed standing on the floor, she brings both heels to-
gether, and walks without feeling the least inconvenience 5
scarcely any ptyalism. Ordered two grains of calomel every
day, and to go on, in other respects, as before.
9th. Seen by Mr. Carmichael and myself; admitted to have
little, if any, vestige of the disease. Mouth slightly affected ;
bowels regular. Says that she feels rather weak, yet in the ab-
sence of her attendant, has been detected in running about the
room, as if she had no complaint. Ordered to have strong beef
tea and chicken broth ad libitum s to take two grains of calomel
every second day; and every vigilance to be used in keeping
her confined to bed, and in the horizontal position.
17th. Scarcely any affection of the mouth. Health, in every
respect good, and feels much stronger; none of the external
signs of the disease visible ; and on being permitted, walks
about the room without feeling the least pain, or any greater
weakness in the left than in the right limb. Calomel dis-
continued. - Permitted’ to have moderate quantities of solid ani-
Ulceration of the Cartilages of Joints. 173
mal food, and light table beer; but still to be confined to the
recumbent position.
30th. Seen by Mr. Carmichael and myself. In excellent
health ; insists that she is “as strong and as well as ever,” and
is very urgent to be allowed to get up and walk about ; and,
after the most careful examination, no difference whatever is ob-
servable in the lower extremities. Directed to be confined to a
sofa; to have a little wine and water, and the most nourishing
articles of food ; and to take half a pint of the compound in-.
fusion of sarsaparilla daily, for some weeks.
After bemg treated thus for three weeks, this young lady
was at length permitted to walk about, and return to her former
pursuits. Since that time, she has had no enlargement of the
lymphatic glands, nor any of the other unpleasant consequences
of the use of mercury in strumous persons; and she is now,
(March the first, 1834), in perfect health.
The following letter and case are from one of the most dis-
tinguished members of the profession in this country, and will,
no doubt, be read with that interest and attention which any
communication from him is sure to excite.
“ Rutland-square, February 20th, 1834.
«© My DEAR SIR,
“ Agreeable to your wishes, I send you a
very brief account of the case of hip joint disease, in which the
mercurial plan of treatment was attended with the most decided
advantage, as it seemed to check at once the progress of the
disease ; an effect which is no doubt owing to the powers which
the exhibition of this mineral possesses in stopping the progress
of membranous inflammation. That the synovial membrane of
the hip joint, and not the cartilage, is often primarily engaged
in this disease, we may infer from one of the first symptoms
which marks its commencement,—a fulness of the groin, de-
pending in all probability upon the increased secretion into the
joint, similar to that which we know takes place in synovitis of
174 Dr. O’Beime on the Use of Mercury in
the knee. You will observe, that as soon as the inflammatory
symptoms had yielded to this treatment, the further exhibition
of mercury was discontinued, and absolute rest, with counter-
stimulants, and the exhibition of sarsaparilla, only enjoined,
«< Believe me to be yours truly,
< RicHarD CARMICHAEL.
Case VI.—* On the 21st of last December, I was called to
the King’s County to see a young gentleman about twelve years
of age, whom I found, on examination, to labour under all the
symptoms of an acute attack of the first stage of morbus coxa-
rius. There were fulness of the groin, flatness of the nates of
the side affected, pain in the knee; and when the heel was
struck, it gave the most acute pain in the joint of the hip. ‘The
patient could not be moved without occasionmg great distress.
When placed in the erect position, he rested on the toes of the
affected limb advanced beyond the other, and there was an ap-
parent lengthening of the former. Pulse rapid, great thirst, and
other symptoms of high symptomatic fever were present. This
boy had, I understood, a bilious fever for some time, and that
the attack above described immediately followed.
«<The frequent application of leeches to the groin and hip was
recommended, afterwards blisters, followed by dressings of tar-
tar emetic ointment applied for half an hour daily. Mercury
was ordered in small doses, so as to affect the gums, but not to
an extent to produce salivation, as the boy had been greatly ex-
hausted by previous pain and symptomatic fever. I didnot see
him again, as I immediately returned to Dublin, but had the
following communication from Doctor Fry, of Forbane. He
writes, on the 12th of January, ‘I have much pleasure in in-
forming you, that our patient has been progressively advancing
towards recovery since I last communicated with you on the
subject. The mercurial action, though not to the extent of sa-
livation, has been with very little intermission, exerted the whole
time. Digestion goes on well, which appears by his bowels
Ulceration of the Cartilages of Joints. 175
acting naturally, once every day and some days twice. Appe-
tite very good. There is now no difference in the length of
both legs, and motion in the affected one can be borne without
apparent pain as formerly. We have, however, adhered to
your wish in enjoining the most perfect quietness.’
“In my reply, I recommended that the mercury should now
be discontinued, that an infusion of sarsaparilla in lime water,
should be exhibited in such quantities as the stomach would
bear without inconvenience; and that the discharge from the
blistered surfaces, on the groin and behind the trochanter, should
be promoted, by dressing them occasionally with tartar emetic
ointment for half an hour.
“On the 2nd of February, Doctor Fry again writes, ‘I
have much pleasure in informing you, that Master has
been steadily advancing towards recovery since my last. ‘The
sarsaparilla with lime water appearing to agree remarkably
well with him. His general health seems quite recovered, and
all inflammatory appearances in the local affection have entirely
subsided. He has occupied his new bed (Karl’s) for some
time. It seems admirably constructed for persons so affected,
and in his particular case, has contributed much to his general
comfort.’ Accompanying this statement, the father of the boy
adds in a postscript, ‘ my little fellow thinks himself so well now,
that he says he could walk, if he was allowed; but, of course,
this is not to be thought of as yet.’ ”
The following case is communicated by my friend, Mr. Cu-
sack Roney, one of the senior surgeons of the Meath Hospital,
a gentleman of very considerable experience, and who has put
the practice to the severest possible test, by employing no exter-
nal applications whatever, and trusting solely to the internal ex-
hibition of mercury.
Case VII.—*“ John Rice, a tanner by trade, aged 17, ro-
bust, and of a scrofulous constitution, having light blue eyes, a
fair complexion, and thick lips; admitted on the 27th of No-
vember, 1833, into the Meath Hospital. ‘The surgeon who
VOL. v. No. 14. 2 A
176 Dr. O’Beirne on the Use of Mercury in
admitted him, directed scarification and cupping behind the
trochanter of the left femur. On the first of December follow-
ing, he was placed under my care, and the appearances noted
were these: apparent elongation of the left lower extremity ; flat-
tening, flaccidity, and unusual breadth of the nates of the same
side; no vestige of the fold formed by the nates of this side ;
and when standing, the knee was flexed, he stood on his toes,
and with the affected limb considerably advanced beyond the
sound one. He complained of severe pain in the knee and at
the groin, but there was no swelling in either of these situations.
When the heel was struck, he experienced acute pain in the
hip joint, and he felt the same sensation when he attempted to
stand or bear upon the affected limb. He said also, that he
was frequently awoke at night by pains, which were much more
severe than those which he felt during the day. On question-
ing him as to those pains, he stated, that they were at first of a
dull kind, and had gradually increased in intensity. His gene-
ral health appeared to be little, if at all, injured.
“ December 3rd. No improvement. Twelve leeches to be
applied to the hip.
“6th. Still no improvement. ‘Tartar emetic ointment to be
freely applied over the whole of the affected hip.
«8th. General pustulation of the hip. Still no change for
the better in the local symptoms.
“12th. Pustules nearly gone, but no apparent change. Tar-
tar emetic ointment repeated.
«4th. No other sensible change in the local symptoms, far-
ther than feeling at ease when he does not move in bed. Seen
and examined by Dr. O’Beirne, who recommended the active
use of mercury, and so as to affect the mouth as quickly as pos-
sible. A scruple of calomel directed to be made into ten pills,
and one of these to be taken thrice daily.
“17th. Mouth very slightly affected. Feels somewhat
easier. Calomel pills repeated.
“19th. A considerable degree of salivation ; slept soundly
Ulceration of the Cartilages of Joints. 177
last night ; both inferior extremities are of the same length ; he
has no pain in either the knee or the groin; the nates of the
affected side is more plump ; and, contrary to the strict injunc-
tions given to him, he has been walking about the ward, and,
apparently, as if he had no complaint of the kind.
«20th. Has persevered in walking about the ward, and he
now declares, that he is perfectly well, and insists upon being
allowed to go home. Discharged; and walked away without
the least limping, or appearing to feel any pain whatever.
« About the latter end of last February, this man again pre-
sented himself at the Meath Hospital, with all the symptoms of
hip disease, in its first stage. He was admitted by one of the
surgeons, who ordered moxa to be applied behind the great
trochanter of the affected side. But he again proved refrac-
tory, refused to permit the application of the moxa, and left the
hospital, without waiting to be discharged.”
With the exception of two or three other cases, the reports
of which have been lost, the foregoing are all those in which
the plan of rapidly mercurializing the system has been em-
ployed in the treatment of this affection of joints. In some of
these cases, the histories show that ulceration of the articular
cartilages supervened on synovitis ; and in others, that it existed
as a primary and independent affection. {In none of them, al-
though the subjects were all more or less scrofulous, has any in-
jurious effect been observed to attend or follow the practice.
In all of them, the quickness with which all the symptoms in-
variably yielded, and ultimately disappeared, on the mouth be-
coming affected, is a very striking and gratifying feature of the
plan employed ; particularly in the cases of morbus coxarius, on
account of the external signs of the disease being more re-
markable in the hip than in any other joint, and of course, more
ealculated to display the effects of the remedy. The case of
hip disease, detailed by Mr. Roney, is, however, particularly in-
structive and interesting. It shows, first, that mercury, unas-
sisted by any kind of external application whatever, is capable
178 Dr. O’Beirne on the Use of Mercury in
of effectually checking the ulcerative process in articular carti-
lages ;—secondly, that no remedy, however powerful, can suc-
ceed in removing the disease, unless the patient be confined to
the recumbent posture, for a time sufficient to favour the repa-
ration of such parts of the articular cartilages as may have been
destroyed by ulceration. How far this mode of treatment will
enable ulcerated cartilages to be repaired by cartilage, and not,
as has been observed hitherto, by a substance closely resembling
the enamel of the teeth, is a point which can only be determined
by time, and a favourable combination of circumstances.
It will naturally be asked, is the mercurial plan of treating
ulceration of articular cartilages, entitled to be considered new?
I am disposed to believe that a brief review of the various kinds
of affections of joints, in which mercury has been employed,
will show that it is. Mr. Brodie recommends moderate doses
of mercurial preparations in cases of synovitis attacking several
joints at the same time. He recommends also, the cautious
use of mercurial frictions at the latter end of the treatment of
synovitis not affecting more than one joint. But he says nothing
of its use in the early stages of synovitis, or when it terminates
in ulceration of the cartilages, or in cases where such ulceration
exists as a primary and independent affection. Moreover, it
does not appear that, in the cases in which he recommends
mercury, his object has been to produce ptyalism. Mr. Aston
Key, who has lately thrown a new light on the ulceration pro-
cess in joints, advises mercurial remedies in what he calls sub-
acute inflammation of the synovial membrane; but he makes no
allusion to their use when that inflammation terminates in ulce-
ration of the cartilages. My colleague, Dr. Ephraim M‘Dowel,
has employed mercury actively, and with partial success, in that
very fatal form of disease, the conjunction of synovitis with pe-
riostitis. According to the Dublin Journal of Medical and
Chemical Science, for last January, Dr. Ebel, surgeon of a
Prussian regiment of infantry, adopting the practice of Profes-
sor Wedekind, has successfully employed corrosive sublimate
Ulceration of the Cartilages of Joints. 179
baths in rheumatic affections of the joints; but it appears that
he does not employ them in scrofulous subjects, in cases where
ulceration of the cartilages has taken place, or with any view to
affecting either the constitution or the mouth. In the sixteenth
volume of the Encyclographie des Sciences Medicales, will be
found, extracted from the Journal Des Connoisances Medico-
Chirurgicales, a report by Monsieur Trousseau, from which it
appears that he and Monsieur Recamier, of the Hotel Dieu,
have also had great success in treating acute rheumatism of the
joints, by frictions of large quantities of strong mercurial oint-
ment over the whole of the abdomen, so as to rapidly affect the
mouth. We see, therefore, that all the articular affections in
which this agent has been employed, have been essentially dif-
ferent in their nature from ulceration of the cartilages. In the
course, however, of my researches on the subject, I have met
with a case in which the articular cartilages may be presumed
to have suffered more or less from ulceration, and in which
mercury, employed in the form of friction, affected the mouth
fully, and removed the disease. It will be found in Professor
Wilson’s very useful and interesting work on the diseases of the
bones and joits, and is as follows: “In one instance indeed,”
says the Professor, ‘in an enlarged knee joint, which appeared
to be of a scrofulous nature, and had taken place in a person
formerly much affected with glandular swellings in the neck,
and had remained nearly indolent for three or four years, upon
its beginning to give pain, one drachm of the mild mercurial
ointment, mixed with some camphore, was ordered to be ap-
plied to its surface, and to remain there during the night ; next
day a soreness of the mouth was felt, which was soon succeeded
by a most violent salivation, the extent of which threatened to
destroy the patient, as she had recently lain in; the swelling,
however, from that single application, began to lessen, and in
three months had completely disappeared: she recovered slowly
of the ptyalism, and so far as I know has remained well ever
since. Sir Everard Home saw this case with me about fifteen
180 Dr. O’Beirne on the Use of Mercury in
years ago.” —pp. 376, 7.—In this case, it is evident, that in or-
dering a drachm of mild mercurial ointment mixed with some
camphor, to be applied, not rubbed, on the joint, the intention
could not have been to produce even slight ptyalism ; and it is
equally evident from the context, as well as from the fact of
the author not recommending the practice, that the ultimate
disappearance of swelling of the joint was looked upon in a
purely accidental light. In every point of view, therefore, it
appears to me, that the mercurial plan of treating the affection
of joints under consideration, has some claims to novelty. But
this is a consideration of very minor importance, indeed, com-
pared with its claims to the attention of the profession, and
which will, [ hope, induce others to give the plan fuller and
more extensive trials. In the meantime, I shall neglect no op-
portunity of pursuing the treatment, and lose no time in laying
before the profession a statement of the results, be they favour-
able. or unfavourable.
I might here be expected to conclude, but there is a point
intimately connected with the foregoing observations and cases,
upon which it will be necessary for me to touch. It is this. I
have said, that we are not without means of anticipating and
preventing the supervention of the injurious effects of the use of
mercury in scrofulous persons; or of combating them when
they have supervened ; and it cannot have escaped observation,
that in the cases which I have detailed, I have preferred the
use of sarsaparilla to all other means of effecting these import-
ant objects. ‘This plant, in the forms of decoction, compound
decoction, extract, and simple infusion in cold water, has ob-
tained such character in counteracting the injurious effects of
mercury, and also in diseases of the joints, that it is unnecessary
to account for the preference given to itsemployment. But seve-
ral important considerations make it necessary to explain why
T have preferred the infusion in lime-water to all other prepara-
tions of the plant. It is necessary in the first place, because
this preparation has not as yet been admitted into any other
Ulceration of the Cartilages of Joints. Si
Pharmacopceia than the Dublin ;—secondly, because it seems to
have been first introduced extensively into practice in this
country, and appears to be comparatively less known or appre-
ciated in Great Britain than it really deserves ;—thirdly, be-
cause the preparation now generally used here, and which has
been employed in the foregoing cases, is, and has long been,
made according to a formula differing, in various respects, from
that laid down in the Dublin Pharmacopeeia, or by Dr. Cop-
land, under the head “Infusum Sarsaparillz Alkalinum,” (see
his Dictionary of Practical Medicine, Part 1., Appendix. For-
mul. No. 258.) These reasons make it expedient to enter into
the following brief account of the origin, progress, and peculiar
claims of the preparation in question.
In the Edinburgh Medical and Surgical Journal, for July,
1820, (see vol. xvi. p. 473,) Mr. Battley of London, informs
the editor, in a short note, that “an elegant and efficacious
preparation” of sarsaparilla, is made by “infusing the en-
tire root in lime-water.” The moment I read these few lines,
the chemical principle upon which the proposed mode of
preparing the plant obviously proceeded, appeared to me
to be so just, that I resolved on giving the preparation a fair
trial, on the first opportunity that offered. Accordingly, ‘on
the 28th of August, 1820, without any formula to direct me,
I ordered two ounces of sliced sarsaparilla to be infused,
for twenty-four hours, on two pints of lime-water, in a glass ves-
sel well stopped, and placed in a cold, dark, situation ; then to
be strained, and the half of this infusion to be taken daily.
The case in which [{ ordered this preparation, was that of the
late Mr. Joseph S
symptoms of syphilis, combined with the effects of the abuse of
, who laboured under secondary
mercury. This gentleman had in vain sought, in Dublin, Lon-
don, and Paris, for relief from severe nocturnal pains, nodes
on the head and in other parts of the body; he had lost all
relish for food, was greatly, emaciated; and amongst various
other remedies, had taken large quantities of all the prepara-
tions of sarsaparilla then known. I have only to add, that after
182 Dr. O’Beirne on the Use of Mercury in
taking a pint of the preparation above described, every day for
six weeks, he was completely freed from all his complaints, re-
gained, and continued to enjoy, a tolerable degree of health and
strength, until the last year, when he died of structural disease
of the heart and liver. He, however, and many others, in
whose cases I had tried this infusion, complained of its taste
being exceedingly bitter and nauseous; and to obviate this ob-
jection, it was ordered to be taken mixed with an equal quan-
tity of new milk. Some could, and others could not, take it in
this form. In several cases also, I found it did not act as ener-
getically or certainly as I had reason to expect. Under these
circumstances, I decided on doubling the quantity of sarsapa-
rilla, and adding liquorice root ; and the result has been, an in-
fusion so singularly efficacious, and so agreeable, that it soon
found its way into both private and hospital practice, and was
afterwards recommended in strong terms by my colleague, Mr.
Carmichael, in his well known work on the venereal disease.
And shortly after the last edition of this work appeared, it was
admitted into the Dublin Pharmacopeeia, but under a very dif-
ferent formula ; in fact, the first, and not the improved formula,
which I had adopted. During nearly fourteen years I have em-
ployed the preparation which I have described, and have seen
it employed by others, extensively, and with the most decided
advantage, in syphilitic and mercurial affections, which had ob-
stinately resisted all the other preparations of sarsaparilla. I
have found it a powerful auxiliary in the treatment of nervous
diseases ; and have used it with manifest benefit in cases of de-
bility and loss of health from various causes; also in scrofu-
lous enlargements of the lymphatic glands; and in irritability
and chronic catarrh of the urinary bladder. In one case, in
particular, a case of catarrh of the urinary bladder, attended by
profuse muco-purulent discharge and great debility, various
remedies, and amongst others, large quantities of lime-water,
were employed without making any impression on the disease,
until this preparation was used, when the discharge ceased in
Ulceration of the Cartilages of Joinis. 183
the course of ten days, and soon after the gentleman rapidly re-
gained strength and health. Its beneficial effects are seldom
observed earlier than about the third week of its use; and the
kidneys are the only organs upon which it apaaets to exert any
sensible action.
Having premised these facts, I shall now insert ee formula
for preparing and using this infusion of sarsaparilla. It is as
follows :
BR. Radicis Sarsaparillee Jamaicensis concise uncias quatuor.
Glycyrrhizee semunciam.
Aquee Calcis libras duas.
Macera per horas viginti quatuor in vase vitreo optime operculato,
et in loco frigido et obscuro; dein cola in usum.
Sumat hujusce infusi dimidium, partitis vicibus, quotidie.
This formula differs from that of the Dublin Pharmaco-
peeia, first, in contaming double the quantity of sarsaparilla ;
secondly, in containing liquorice root; thirdly, in requiring the
infusion to proceed for twenty-four, instead of twelve hours ;
fourthly, in not requiring agitation of the contents of the vessel.
This formula also differs from that given by Dr. Copland, first,
in containing double the quantity of sarsaparilla ; secondly, in
not requiring the sarsaparilla to be bruised ; thirdly, in not re-
quiring agitation of the contents of the vessel ; fourthly, in re-
quiring the glass vessel to be very well, instead of slightly stop-
ped. There is but one of these differences that I have not sa-
tisfactorily accounted for, and it respects the time allowed for
the infusion by the Dublin Pharmacopoeia. Experience has
long convinced me, and the following experiment, which I have
repeatedly seen tried, will, I think, convince others, that that
time is by one half too short to complete the process of infu-
sion. ‘The experiment was conducted thus, and. with the fol-
lowing results. A stream of carbonic acid gas‘ was directed
into a quantity of the compound infusion of sarsaparilla, which
had been prepared in twelve hours, when the liquid, from
being clear, became quite turbid, and a white precipitate was
VoL. v. No. 14. 2B
184 Dr. O’Beirne on Ulceration of the Cartilages of Joints.
observed collecting at the bottom of the glass. A stream of
carbonic acid gas was next directed into a quantity of the same
preparation made in twenty-four hours, but the quid remained
as clear as before, and no precipitate could be observed. This
is an extremely interesting fact, and shows, that the small quan-
tity of lime contained in the lime-water, enters into intimate
combination with the active principles of the sersaparilla and the
liquorice ; and with them formsa new substance, which is perfectly
soluble in cold water. Dr. Anthony Todd Thomson, in comment-
ing upon the Dublin formula for this preparation, says, that “ the
active principle of the sarsaparilla is soluble in cold water,” and
that, “the use of the lime-water is not satisfactorily explained.”
There can be no doubt, that the active principle of sursaparilla
is soluble in cold water, but I doubt much that it is so to the
same extent as in cold lime-water ; and my reason for thinking
thus, is this. Several years ago, I requested Mr. Daly, of
Henry-street, in this city, who first made the preparation, to
supply me with some of the sarsaparilla which had been sub-
jected to infusion for twenty-four hours in lime-water. Upon
this, after adding liquorice root, I had fresh lime-water poured,
the glass vessel well stopped, and left to infuse for the time just
mentioned. ‘Thus prepared, this second infusion was adminis-
tered, for some weeks, to several patients in the Charitable In-
firmary, Jervis-street, of which I was then one of the surgeons,
but it was found to be totally inert and useless. Hence it ap-
pears that lime-water takes up the whole of the active principle
of sarsaparilla. All these facts will, I trust, satisfactorily ex-
plain its use in preparing this plant, and exhibit the superior
powers of the preparation, into the composition of which it
enters.
To conclude, it appears to me that the name given to this
preparation, by Dr. Copland, is more applicable and expres-
sive, than that given to it by the Dublin College.
Mr. Poole’s Case of Pneumo-thorar Jrom Perforation. 185
Arr. XII—.4 Case of Pneumo-thorax from Perforation.
By Ricuarp Poon, Esq., Assistant Surgeon, 32nd Regi-.
ment.
Private J. Rowe, 32nd regiment, admitted into hospital at
Tralee, March, 27th, 1832. He was a healthy looking lad
on joining the regiment about six months ago; there was,
however, slight malformation of the chest, the subclavian
regions being shallow, the submammary cylindrical or bulging.
Fad an attack of pneumonia two months ago, which was treated
actively, but the patient was for some time afterwards troubled
with a bronchial affection. Present complaint, violent cough, dys-
pnoea, with thin, viscid, mucous expectoration of a pale straw co-
lour, and pretty copious ; no decided loss of resonance, nor any
morbid sound detected in the chest, except occasional mucous rales
in the lower left lobe. The disease was considered bronchitic,
and treated in the first instance, with antimonials, and then
with the balsams; under this plan, with milk diet, and counter-
irritation, he improved very much, and regained in a great
measure, a healthy look, presenting only some acceleration of
pulse, occasional morning cough with scanty expectoration, and
slight dyspnoea.
On the 27th April, the lower portion of the right side gave
a dull sound on percussion, and here the respiratory murmur
became indistinct, but no aggravation of the symptoms took
place until the beginning of the month following, when the
cough became again troublesome, and he began to look pale
. and unhealthy ; the pulse was still quick, and heat of skin to-
wards evening considerable. On the 12th May loud bronchial
breathing was detected in the mammary region of the left lung,
with bronchophony, but no ronchus, the resonance continuing
unimpaired. It was inferred that some dilatation of the bron-
chial tubes existed. On the 21st a remarkable change took place,
186 Mr. Poole’s Case of Pneumo-therax from Perforation.
the patient having been attacked with pneumonia of the lower
part of the left lung, which yielded to general bleeding and large
doses of the tartar emetic, not, however, before hepatization had
taken place to some extent. After the signs of this latter lesion
had entirely disappeared, a mucous rale persisted through the
whole of the posterior portions of the lung, the anterior part
giving a clear sound on percussion, until the 1st July, when the
metallic tinkle was distinctly heard, and a diagnosis of pneumo-
thorax made, although the respiratory murmur and a deep gurg-
ling could be distinguished in the portions of the lung, over
which percussion elicited the clearest sound. ‘There never exist-
ed any signs of an excavation, but the patient coughed up, on the
Ath and 5th of the month, a large quantity of a sero-albuminous
fluid, proving that a communication existed between the lung
and the sac of the pleura. From this time he sank rapidly, and
expired on the 6th of the month.
Autopsy, twelve Hours after Death.—Considerable maras-
mus ; left side of the chest, at the inferior portion, much
bulged out, highly sonorous, in fact, tympanitic ; right side gave
generally a dull sound on percussion: on cutting through the
cartilages of the left ribs, a rush of inodorous gas took place
from the pleural cavity. The lung was found condensed, and
pressed up towards the spine and back part of the ribs, to
which it was bound by strong adhesions. A small quantity of
a yellow coloured serosity existed at the bottom of the cavity.
The surface of the lung was covered with several loose layers
of false membrane, of a lemon colour and tough consistence ;
they were readily detached from the lung; the lung was firm
and corrugated, it was perforated by a considerable opening,
which existed at the back part of the upper portion of the lower
lobe, close to the adhesion with the costal pleura ; the finger
could be passed by this opening into the substance of the lung,
and it was found that a small quantity of purulent matter
escaped by it when the lung was pressed. The parenchyma of
this lobe was thickly infiltrated with tubercular matter in a crude
Mr. Poole’s Case of Pneumo-thorax from Perforation. 187
state ; one or two points of suppuration were observed, but an-
teriorly there was no excavation. On the back part of the lobe,
however, corresponding with the situation of the fistulous open-
ing, existed a considerable irregular cavity, which had through
this discharged its contents into the pleural sac. ‘The upper
lobe of this lung was quite sound, and did not contain a single
tubercle, but all its bronchial tubes were much dilated, their
lining membrane highly vascular, without any apparent hyper-
trophy. The sac of the right hing contained some serosity, but
the lung itself, with the exception of its lower lobe, which was
thickly studded with crude tubercles, was sound and crepitous.
Observations.—This case was clearly one of pneumo-
thorax from perforation, the atmospheric air having escaped
into the pleural sac by means of the fistulous opening that ex-
isted in the back part of the left lung. So far there is nothing
uncommon ; but from such a case it may be readily shewn, how
considerable reparation might be effected in the diseased parts,
provided life could be sustained so long, by which, not merely
might a stop be put to further disorganization, but also all traces
of the original mischief be completely obscured. It is, in fact,
only necessary to allow the possibility of the atmospheric air
that escapes into the pleural sac producing, as in the present
instance, a pleuritis with membranous exudation, some layers of
which are deposited over the fistulous opening, and prevent the
further entrance of the atmospheric air; to show that this repa-
tion may be effected, and to establish a rational explanation of
some forms of pneumo-thorax, at present attributed to causes
much less readily assignable : we can easily understand how, under
such circumstances, all traces of the fistulous opening may be
completely lost, and how, after the lapse probably of years, we
should in such a case discover nothing but a lung contracted
and bound up into a certain part of the thorax by strong cellular
bands, while the other portion of the pleural cavity contained
nothing but inodorous gas. Such views are not altogether
hypothetical, for I can only explain in this way a case I ob-
183 Mr. Poole’s Case of Pneumo-thorax from Perforation.
served about four years ago, in which, the patient, a healthy
young lad, dying from epilepsy, I was afforded an opportu-
nity of seeing in the right side of the chest, the appearances
described above. In this case, there was no contraction of the
side, nor do I see, explaining it as I have now done, how such
could have taken place.
In the case of Rowe, the fistula, certainly, remained open to
the last, but there are several cases on record in which a fistula
of the lungs has been closed. In addition to these, there are
other circumstances I need not detail here, which may lead us
to differ with Laennec in attributing to secretion, (exhalation),
or the decomposition and putrefaction of the pleural effused
fluids, the existence, in several of his cases, and particularly
those in which pulmonary excavations were found, of gas in the
cavity of the pleura. Andral’s views on this point are evi-
dently at issue with those of Laennec, for he states expressly,
that in almost all stances pneumo-thorax takes place from per-
foration. It appears to me also, that the second case recorded
by Dr. Graves, in the last number but one of this Journal, stands
in a very doubtful light, and I am far from concurring in the
view he has taken of the impossibility of atmospheric air, intro-
duced through a fistulous opening, exerting pressure on a lung
sufficient to render it in a condition that might be termed
“carnefied.” It is known, however, that Laennec has re-
stricted, with what justice [ am not going to question here, this
term to the inflammation of the lung under pressure. Now,
if the state of the lung in Dr. Graves’ case resembled this, I
can readily appreciate the value of the observation it has given
rise to, but if the term is applied in this instance simply to ex-
press a condition of the lung characterized by compression, and
absence of all crepitation, I have only to state, that in the case of
Rowe the lung was but little crepitous, and had undergone con-
densation to such an extent, as to have become remarkably shrunk,
and as it were wrinkled, from the compression alone of the at-
mosphericair. I have, therefore, to repeat, that we should hesi-
Mr. Porter’s Report of Surgical Cases. 189
sitate to admit this case as an example of pneumo-thorax from se-
cretion (exhalation). The other case detailed by Dr. Graves ap-
pears, however, an admirable example of this interesting lesion,
and corroborates, in some measure, the views of M. Gendrin, that
an exhalation or secretion of air is frequent in connexion with
pleuritis. Gendrin appears, however, to attribute this pheno-
menon to active rather than mild examples of this disease. Dr.
Graves’ case appertains to the latter.
Art. XIII.—Surgical Report of Cases, treated in the Meath
Flospital during the past Year. By Wi.u1am Henry Por-
vER, Lecturer on Anatomy and Surgery in the School of
Anatomy, Medicine, and Surgery, Park-street, Dublin.
Tue general practice of all hospitals must be nearly the same,
and as the leading characters and treatment of the ordinary
forms of disease are pretty accurately understood, very detailed
reportsare neither necessary nor instructive, unless when adduced
for the purpose of establishing some important pathological fact,
or introducing some improvement in practice. But in every
establishment of this kind, particular cases will occasionally
occur, not only novel in their nature, and therefore curious, but
by reason of their infrequency, difficult and uncertain in their
management. By the publication of such cases, in an authentic
form, the hospital surgeon may confer the greatest benefit on
his profession, for he enables the practitioner, of extensive Op-
portunities, who has met with similar cases, to compare the ob-
servation and experience of others with his own, and thereby
approach the truth ; whilst to the younger practitioner, he fur-
nishes a guide and assistance in the difficulties of his profession,
which, though far from perfect, may nevertheless be valuable.
In this spirit and with this view I have selected the following
cases, each possessing its own peculiar interest, and on which I
190 Dr. Porter’s Report of Surgical Cases,
forbear to offer comment or observation, wishing to render the
details as short as shall be consistent with clearness ; and know-
ing that the case, which to the practitioner at the bed side will
appear rare, or difficult, uncertain, or important, may to the
reader in his closet, deprived of the numerous aids derived from
personal inspection, seem to possess little more than ordinary
interest, and unworthy of being obtruded on the profession.
1. Aneurism occasioned by the sequestrum, in a case of ne-
crosis of the tibia.
2. Functional derangement of the brain, the result of injury,
cured by the operation of the trepan.
3. Curious and interesting case of bronchotomy.
4. Disease of the lymphatics of the left arm, amputation at
the shoulder joint.
Case 1—Aneurism in a Case of Necrosis——Death from
Mortification and Hemorrhage.—Post Mortem Appear-
ances.
John Jackson, et. 29, of delicate habits, and had been a
hard drinker, admitted January 2nd, 1833.
Eistory.—He stated that several years previously (perhaps
fourteen or fifteen) he had been seized with a violent pain in
the left knee, which, as well as the lower part of the thigh,
shortly afterwards swelled to a great size, but without redness.
This tumefaction subsided a little under the use of blisters, but
the knee always remained larger than that of the opposite limb.
About a year afterwards a small swelling appeared four or five
inches above the knee, on the inside, which he opened himself,
and gave exist to some purulent matter ; a fistulous opening has
remained there discharging ever since. In the month of Au-
gust, 1832, he had a very alarming hemorrhage from this fistu-
lous opening, but there was no recurrence of it until the night
before his admission into hospital, when he bled with great vio-
lence; the blood, at intervals, spirting forth to a considerable
distance, at others.trickling down the limb, but in neither case
was he able to restrain it. He supposed himself to have lost
treated in the Meath Hospital. 191]
several quarts, and fainted from exhaustion seven or eight
times.
Symptoms on admission.—His face appeared quite blanch-
ed and expressive of the greatest anxiety ; extreme exhaustion ;
thirst ; pulse small and thrilling, 150. On removing the sheet
in which the limb was wrapped, a small, livid, fistulous opening
was seen on the outside of the lower third of the right thigh,
slowly discharging a thin, serous blood, on pressing which the
finger seemed to sink into a deep cavity ; pulsation was quite
distinct, and bruit de soufflet audible for some distance round
it, as if from aneurism : the femur, at its lower third, could be
felt enlarged, and the popliteal space filled up, but the pulsa-
tion of the artery below it was distinctly perceptible. The
weakness of the patient prevented any farther or more accurate
examination, and it seemed to be a case of popliteal aneurism
complicated with diseased bone ; the sac having probably burst
into the cavity of the abscess in connexion with the bone. He
complained of intense pain in the knee and throughout the tumour,
A compress of lint was put over the opening, with a bandage
rolled from the foot, over and above it. Lemon juice ad libitum.
Jan. 3rd. There was some bleeding during the night, which
oozed through the compress and bandage. He was this morn-
ing seized with severe vomiting. Pulse 150, full and hard.
4th. Vomited all night. This morning intense pain in the
thigh ; face quite bleached with a yellowish tinge, and an inde-
scribable expression of anxiety ; thirst very urgent; pulse 142.
Yn consultation amputation was decided on as offering the only
possible chance, however slender, but he steadily refused to
submit, although warned that a few hours would render the
adoption of this only remedy impossible. He had effervescing
draughts, with tincture of opium.
oth. Symptoms nearly the same, with increasing debility.
6th. No cessation of the vomiting ; great pain in the limb ;
the thigh above the bandage greatly swollen and yellowish ; on
its posterior surface gangrenous nearly as high as the buttock ;
immediately under the compress a patch of sphacelus. The
VOL. v. No. 14. 2C
192 Mr. Porter’s Report of Surgical Cases,
vomiting continued, and a constant, though feeble hemorrhage,
trickled from the limb. He gradually became weaker, and
died about nine o’clock, p. M.
Dissection.—On opening the popliteal space, it was found
filled with thick grumous clots, extending up as high as the
lower third of the femur, in contact anteriorly with the bone,
and with something that appeared to be part of the sac, but
whether of an aneurismal sac, or the cyst of a former abscess,
could not be determined. An opening existed in the popliteal
artery, a little below the spot where it enters the space. ‘The
thigh bone was found diseased in its lower half, being consider-
ably enlarged, its surface rough, and a large portion of the pos-
terior or popliteal aspect destroyed, so as to permit the intro-
duction of the fingers into a large cavity within ; the edges of
the bone on each side of this opening were thick and very full
of rough sharp points ; in the upper part of the excavation the
sharp point of a sequestrum was discovered, moveable, and
accurately corresponding to the aperture in the artery, which it
evidently seemed to have occasioned. The knee joint filled
with a yellowish serum, unlike ordinary synovia; its capsular
ligament thickened. The cellular tissue of the entire thigh
filled with a reddish serum.
Case IL.—Fracture of the Os-frontis.—Symptoms of Idiotcy
and Paralysis, supervening after some interval.— Opera-
tion of the Trepan.—Slow but ultimately perfect Recovery.
Edward Hughes, et. 35, a strong healthy countryman, ad-
mitted into hospital June 26th, 1833; he had been returning
from a fair on the evening of the 8th May previously, and in a
scuffle with some persons who attempted to rob him, received
a blow of a large stone nearly in the centre of the forehead,
which knocked him down, and caused a depressed fracture of
the os frontis. He was not rendered senseless by the blow,
nor for some time afterwards was there any perceptible conse-
quence, as during the six subsequent weeks he was able to
work, and had his intellects perfect and natural. His friends
then observed him to become drowsy, listless, and incoherent :
treated in the Meath Hospital. 193
when undisturbed he was quite idiotic, but when roused he ap-
peared to possess some memory. His manner of answering a
question was very remarkable; he hesitated, seemed to recol-
lect with difficulty, and answered as if in doubt. He tottered
in his gait, and had a remarkable tremor in his left arm and
hand: the tongue, when protruded, was drawn to the left, and
there was also strabismus of the left eye.
Considering that the subsequent symptoms had some direct
connexion with the injury of the skull, I determined on expos-
ing and examining the bone, and being then governed by cir-
cumstances. I found an irregular fracture of nearly an inch in
length, one side of which was depressed to the depth of little
more than three lines. The trephine was then applied, in order
to permit of the elevation of the depressed bone, but the inter-
nal table was found to have been so extensively broken, that
three crowns of the instrument were removed before all the
fragments could be exposed and taken away; one large portion
had penetrated the dura mater, and entered the substance of the
brain, the removal of which was followed by considerable he-
morrhage, appearing to come from some vessel of the brain it-
self, and which could only be controlled by the application of
several compresses, and such a degree of pressure as evidently
affected the functions of the organ. He bore the operation to-
lerably well, and continued during the remainder of the day
listless and in a half sleep; pulse slow, small, and weak.
June 29th. (The day after the operation.) Elad remained
tranquil during the night, and turned himself from one side to
the other in the bed; but to external objects was nearly insen-
_ sible ; his evacuations passed involuntarily ; pulse weak and
_ labouring. On the removal of the compresses and dressings
he became more lively, and his pulse more full.
30th. His evacuations are still passed unconsciously ;
tongue covered with a dark fur in the centre; pulse 86, and
strong ; no pain in the head; can swallow well, and appears
much more sensible. He lies in a kind of slumber, but is very
easily roused.
194 Mr. Porter’s Report of Surgical Cases,
July Ist. No pain in the head ; pulse 110. This day, for
the first time, he became conscious of his natural wants.
It is unnecessary to detail the treatment which was strictly
and actively antiphlogistic, or the symptoms, which were those
of progressive improvement until the 16th July, when he had se-
veral severe rigors, and trembled violently ; pulse rapid and
fluttering ; eyes peculiarly wild ; he is drowsy and stupid.
18th. Pulse small, weak, and very irregular. He is quite un-
conscious of his natural wants, and appears nearly idiotic. ‘The
tremors are very remarkable, particularly of the left arm and
leg, which he cannot keep quiet for a moment by any effort.
The bottom of the wound is covered with white granulations
resembling fungus, and the discharge very profuse, and rather
fetid. He was ordered calomel and opium with a view to affect
the mouth.
28th..In proportion as the effects of the mercury became
developed, the patient’s health improved, and on this day he
might be pronounced quite convalescent. The trembling of
the limbs has totally disappeared, and all pain removed ; he is,
however, very weak.
Aug. 10th. He is now completely recovered, and is perfectly
rational ; he walks about as strong as ever, and assists in doing
several things about the hospital: he wears a large plate over
the wound, which is nearly healed. He remembers most of the
circumstances that occurred during his illness.
This man was able, in the November following, to walk to
Dublin, a distance of twenty-three miles.; He called on me, and
expressed himself as being in as good health as he had been at
any period previous to the accident.
Case III.—Case of Bronchotomy, for the removal of a Foreign
Body, supposed to be in the Larynx. Relief not obtained.
Difficulty of determining the Nature of the Case. Subse-
quent Recovery imperfect.
James M‘Mahon, et. 14, hitherto very healthy, admitted
into hospital August 27th. In the previous June, whilst eating
treated in the Meath Hospital. 195
some beef-hash, a piece of bone or gristle seemed to have
stopped in his throat, and he was instantly seized with all the
symptoms of suffocation, violent cough, &c. He remained in
this state for some days, with great pain and difficulty of swal-
lowing, and of turning the head to the left side. He got some
medicines from his mother, but being still unrelieved, he was
brought to an hospital, where a probang was passed down the
cesophagus with some ‘slight temporary benefit. In a short
time, however, the symptoms returned with increased violence,
and he was then recommended by a clergyman for admission
into the Meath Hospital.
Symptoms on Admission.—Deglutition so difficult and pain-
ful as to make him refrain from drinking, although very thirsty ;
he cannot turn his head to the left side without great suffering ;
voice nearly lost; breathing loud and sibilous ; the wheezing
greatly increased during the spasmodic paroxysms, which are
very frequent. The face is pale and livid, the lips purplish.
He opens his mouth badly, but as far as the condition of the
fauces can be ascertained, there are no traces of inflammation.
On passing the finger into the fauces, the epiglottis can be felt
of its natural size,and healthy. Pulse rapid ; skin hot and dry.
The cause of all this distress appeared to be very obscure, but
as the commencement of the disease seemed traceable to some
accident in the process of deglutition, and rendered it probable
that some foreign body was impacted in the ventricle of the la-
rynx, I proposed the operation, to which the boy’s mother for
two days refused to consent. At the end of this period, the
symptoms having become aggravated, the operation was per-
formed.
Thiswas one of the most difficult and embarrassing operations
in which I had ever been engaged, the annoyance having been
principally caused by the first incision having been accidentally
made a little to the right of the mesial line of the neck. Some
large veins were thus exposed that could not be completely
avoided, and the hemorrhage was so great as not only to ob-
196 Mr. Porter's Report of Surgical Cases,
scure a view of the parts, but to threaten danger from the quan-
tity of blood lost. The trachea was extremely small, and was
difficult to fix, and when after some delay it was opened, a
quantity ofblood rushing into the trachea rendered the patient’s
condition very precarious: violent cough succeeded, with respi-
ration quick, difficult, and laborious. The larynx and trachea
moved rapidly up and down the neck, and although after the
opening had been cleared, a great quantity of thick mucus was
expelled, I had never seen an operation by which the patient
seemed to be less relieved.
During the afternoon and throughout the night the breath-
ing continued very laborious, frequently obstructed by mucus,
which required to be constantly removed. Whenever the ca-
nula became foul, or the air passage from any other cause in-
terfered with, a paroxysm of suffocation supervened, and he ap-
peared at the point of death. No sleep during the night.
August 30th. He appears much easier, and will occasionally
lie for half an hour or more perfectly tranquil, but the moment
the wound is in the slightest degree obstructed, he falls into a
paroxysm of suffocation, and works and struggles almost convul-
sively. The wound is somewhat swollen, and he cannot endure
the presence of the tube, but on its withdrawal, as it is difficult
by any contrivance to keep the edges open and free, a fresh
paroxysm of difficult breathing is produced. ‘Two pupils sit at
his bed side night and day, and it sometimes requires all their
exertions to keep the wound sufficiently open, and save him
when attacked by one of these paroxysms, Ordered small
doses of tartarized antimony.
3lst. Had a very severe attack from the accumulation of
mucus, and the closure of the wound, which was relieved by the
forcible dilatation of its lips by means of forceps. An abomina-
ble fetor exhaled from the wound, like that observed in cases of
abscess and ulceration of the larynx. Some slight stethoscopic
indications of bronchitis, but the sound of the respiration through
the wound is heard all over the chest, and renders every other
indistinct.
treated in the Meath Hosjntat. aoe
September 6th. He has been gradually improving since the
last report. Very large tubes have been obtained, and two or
three of them lie by his bedside, that one may be always ready,
clean, and free from obstruction. Still nothing had been ac-
complished by the operation. The moment a finger was laid
on the orifice of the tube, respiration stopped : if withdrawn for
an instant the convulsive breathing was renewed, and it became
evident, that the obstruction (whatever it might be) was situ-
ated above the wound, and probably in the immediate neigh-
bourhood of the rima glottidis. I resolved on making a close
examination of the parts, which I did by means of eye and
probe without discovering any thing; but still dissatisfied, |
passed a large sized bougie from the wound through the rima,
and out by the mouth. The instrument passed with facility
from above and from below, and not the slightest indication of
the existence of any mechanical obstruction could be observed.
Yet the larynx remained perfectly incapable of performing its
function of transmitting air to the lungs.
For several days afterwards, I passed the bougie without the
least good effect. He continued gradually improving in health
and strength, and the paroxysms of suffocation occurred less
frequently, as he had acquired some dexterity in introducing
the tube for himself, and thus anticipating any serious attack.
I find, however, that occasionally he incurred considerable
danger when the mucus accumulated during sleep, and in the
night of the eleventh such an occurrence had nearly deprived
him of life. All the functions, circulation, digestion, &c. regu-
lar and natural.
16th. He sleeps now nearly the entire night through: is
able to take out the tube and clean it himself, therefore, no
longer requiring attendance as formerly: he is up and walking
about the wards, but not the least symptom of air passing even
in the smallest quantity through the rima.
This patient was retained in Hospital for more than six
weeks subsequently, with the double purpose of watching
198 Mr. Porter’s Report of Surgical Cases,
whether some foreign substance might not be accidentally ex-
pelled, and thus throw some light upon the case, and lest some
sudden and severe paroxysm, attacking him when removed from
professional assistance, should prove fatal. During this period
he was seized with acute bronchitis, in consequence of exposure
to cold, for which he underwent a full course of calomel and
opium, and recovered, but still the affection of the larynx con-
tinued : not a particle of air passed through the rima, and he
left the hospital with every probability of being obliged to wear
the tube, and exist by artificial respiration during the remainder
of his days.
During the night of the 21st December, in consequence of
the tube being nearly closed up by inspissated mucus, he was
seized with a dreadful paroxysm of suffocation, and must have
perished but for the timely assistance of Mr. Crampton, who
was called to him. On the following day he was re-admitted
into hospital, more for the purpose of receiving occasional re-
lief in these paroxysms than in the hope of any permanent bene-
fit. Here he again suffered from an acute attack of bronchitis,
for which he was treated as before, and recovered. ‘Towards
the latter end of January, he unexpectedly found, that on clos-
ing the tube, a small quantity of air passed by the larynx, and
he could speak in a feeble tone, but sufficiently distinct to be
understood. The process of natural respiration seemed slowly
and gradually about to be restored, and occasionally he could
remain with the tube closed for half an hour or more. On the
28th January he left the hospital.
I have lately seen this patient, and though greatly improved
he still wears the tube, nor would he dare to sleep without it ;
there is, however, every reason to believe, that he will shortly be
able to dispense with it altogether, and the function of the la-
rynx be completely recovered.
The cause of the obstructed respiration was never satisfac-
torily discovered, nor was there any reasonable conjecture
offered on the subject. At the period when it was at its great-
treated in the Meath Hospital. 199
est height, the bougie passed with the greatest facility through
the rima, which, as well as all the adjacent parts, seemed to be
perfectly healthy.
Case IV.—Case of Disease of the Lymphatics of the Arm.
Amputation at the Shoulder Joint. —
Michael Hughes, etat. 29, of a scrofulous and emaciated
appearance, admitted on the 27th November, 1833, for anaffec-
tion of his left arm of a very peculiar nature.
The limb is semiflexed and slightly swollen at the elbow,
the hand bent downwards at the wrist; the knuckles bent also,
and every one of these joints permanently rigid. There is an
eruption on the hand, which is itchy and troublesome. The
veins of the arm swollen and prominent, but not hard or knot-
ted. The pulse at the wrist so weak as to be scarcely percep-
tible.
An irregular line of small tumours, resemblin g¢ tubercles, ex-
tends along the arm from the axilla in which the largest is si-
tuated ; they are of a stony hardness, and firmly attached to the
adjacent structures; some of them are ulcerated, others sur-
rounded by a dark blush of inflammation. The pain he expe-
riences is dreadful, and deprives him entirely of rest. He en-
treats that something may be done for him, and will submit to
any operation that holds out even a chance of relief. The his-
tory of this case is shortly this. The tumour in the axilla was
the first formed, and appeared four years previously, after a day
of very hard work ; its growth was slow and irregular, some-
times increasing, sometimes diminishing, and never very pain-
ful. The gland next below it then swelled, and thus the dis-
ease continued to spread along the arm in the direction con-
trary to the course of absorption. Several months previously he
had been in hospital, under the care of my friend Doctor Graves,
and was treated with iodine, and (I believe) every other medi-
cine that offered even a chance of success, but without any ma-
terial benefit. At that period I was consulted on the case, and
considering the tumour in the axilla to be the chief, as well as
VOL. Vv. No. 14. 2D
200 Dr. Porter’s Report of Surgical Cases
the original cause of the mischief, hinted, that nothing short of.
its removal could prove serviceable, although the possibility of
such an operation was very questionable, as it.seemed evident,
that the great axillary vessels were closely connected with the
diseased eland; perhaps enveloped by it. He heard some
whispering about an operation, and quitted the hospital without
leave. 7 | :
During his absence he applied corrosive sublimate to the.
tumours, for the purpose (as he expressed it) of cutting them
away, and produced some frightfully irritable ulcers. The pain.
now became so intolerable that he applied to me, and was again
admitted into hospital. '
Nothing offered any prospect of relief but amputation at the
shoulder joint, nor was this exceedingly promising, as he had a
slight cough, and observed his expectoration to be triflingly
streaked with blood. His chest was minutely examined: it
sounded well on percussion, and the respiratory murmur healthy
and distinct. It appeared that nothing directly contra-indicat-
ing the operation could be proved to exist, and as he solicited,
that something should be done, it was determined in consulta-
tion that the part should be removed.
The operation was performed in the usual way, by making a
flap of the deltoid muscle, the tumour in the axilla rendering,
any other mode of proceeding impossible. In removing the
limb, the tumour was divided, and it was discovered that the.
artery, vein, and plexus of nerves were encompassed by it, a cir-
cumstance that rendered the securing of the vessel difficult. A
temporary ligature of safety was then placed round all, and the
tumour dissected out, the arteries tied, and the flap laid down,
and secured by a few stitches. The patient bore the operation
very well, but having lost a considerable quantity of blood, be-
came weak, and was almost sinking, his pulse feeble and tremu-
lous, his voice faint, and his limbs cold. Warm wine and water
was administered, and jars of hot water to his extremities. A
full opiate was ordered, but immediately rejected from his sto-
treated in the Meath Hospitat. : 201
mach. Altogether his condition was most precarious, until to-
wards evening, when he rallied a good deal, and from that mo-
ment every thing, so far as the wound was concerned went on
favourably, the ligatures came away at the usual periods, and at
the end of five weeks he was recovered so far as to be able to
leave the hospital. But the ultimate safety of this patient is
very questionable. About three weeks after the operation he
was seized with cough and difficulty of breathing, amounting to
orthopneea, he expectorated a considerable quantity of blood,
had nocturnal perspirations, and lost flesh, for which symptoms
he was removed to the country as soon as the condition of the
wound permitted. |
I have since heard of him very frequently, and he continues
pretty nearly in the same situation, with cough, and the other
pectoral symptoms. Although the direction of the disease ex-
ternally was in a line contrary to that of absorption, it seems
not improbable, that the bronchial glands had also become en-
gaged, and of course the present symptoms are not much under
the control of medical treatment.
Although unrelieved by the operation, the case appears in-
teresting, as offering an example ofa disease of the lymphatic
glands, (as far as I know), not hitherto observed or described.
The dissection of the arm exhibited a number of these glands
indurated, others ulcerated, but all exhibiting proofs of their
malignant nature. Several glands, however, were found healthy,
and without any alteration of structure. One in the axilla, close
to the large original tumour, was slightly increased in size, and
softened in consistence. ‘Lhe artery, vein, and nerves, had
passed through the centre of the indurated gland, and the for-
mer vessel had been so compressed, that its calibre scarcely
equalled that of a small crow-quill. The axillary vein was also
compressed, whilst the cephalic was increased in size. Having
passed the tumour, the artery again seemed to expand into its
natural size, but still the compressed state of the vessel was in-:
dicated before the operation, by the smallness and feebleness of
»
202 Dr. Porter’s Report of Surgical Cases, §c.
the pulse. The distention of the superficial veins showed, that
the circulation through the deeper trunks was more or less im-
peded. The crookening of the fmgers, the rigidity of the
joints, and the itchy eruption, probably had some connexion
with the pressure exercised by the tumour on the nerves. ‘True,
our knowledge of the pathology of these important organs is
still so imperfect, that this opinion can have little more weight
than mere conjecture, but in three cases of subclavian aneurism,
which I had under my care at different times, I observed a
similar eruption and crookening of the fingers, which were re-
moved after operation, when the pressure of the tumours was no
longer exercised. In these latter cases the joints were certainly
not rigid, but then the pressure had only existed a few weeks,
whereas in the case of Hughes, it had been in operation four
years. These considerations on the effect of pressure on the
nerves, appear to me important, for it is only by collecting facts
and comparing them with each other, and with the symptoms
apparently resulting from them, that any thing approaching to
sound pathological knowledge can be established.
I had intended to have added some other cases to this re-
port, as having occurred within the past year; amongst them
that of the man whose face was nearly eaten off by a pig, but
independent of the length to which these details have been al-
ready drawn out, I find, that the interest of this case would not
compensate for the disgust its perusal would occasion. It
merely tended to shew, first, that a man deprived in this rough
manner of his nose, both cheeks, both lips, and part of both
ears, might recover notwithstanding ; and secondly, it exemplified
the uses of the lips to the functions of speech, mastication, and
deglutition. It was remarkable, that soon after the accident,
he could pronounce the labial letters tolerably well, a power
which he lost as the wound progressed in healing, and of which
he was entirely deprived before he left the hospital. His arti-
culation of course was very indistinct. He lost more than half
of the solids he attempted to chew, for want of the lips to keep
Dr. Beatty’s Case of Trial for. Poisoning by Arsenic. 203
them under the teeth, and a considerable portion of the fluids
escaped in his attempts to swallow. His chief regret was the
being deprived of the use of tobacco, which he was incapable of
using in any form, on account of the loss of his nose and lips.
All the saliva secreted by the parotid glands escaped, and seve-
ral attempts were made to ascertain the quantity produced in a
given time, but they were defeated by the irritability of the pa-
tient. Although deprived of so large a portion of this fluid, I
did not find that the process of digestion was at all impaired.
Art. XIV.—.4 Case of Trial for Poisoning by Arsenic. By
THomas Epwarp Brearty, M.D. M.R.I.A., Professor of
Medical Jurisprudence to the Royal College of Surgeons in
Ireland, Accoucheur to the New Lying-in Hospital, and
Consulting Accoucheur to the Baggot-street Hospital, Dub-
lin. .
THERE is no part of medical practice, wide as that field is,
which more imperiously demands not only a thorough acquain-
tance with all the particulars relating to it, but also a readiness
in making that knowledge available when opportunity requires,
than those cases in which we are called on to give an opinion
respecting the administration of poison. The difficulty varies
in degree according to the circumstances of the case. If we see
the patient during lite, and have an opportunity of witnessing
the symptoms under which he labours; if some remains of the
poisonous dose be forthcoming, or if the contents of the stomach,
as ejected by vomiting, be preserved ; and if after death we have
an opportunity of examining the body, much of the obscurity is
obviated, and the case is one of comparative simplicity. ‘The
difficulty is increased, when the sufferer is dead before we see
hin, when we can only learn the history of his previous state
from ignorant by-standers; and when none of the evacuations
204 Dr. Beatty’s Case of Trial for Poisoning by Arsenic.
from the stomach or intestines are available for the purpose of
analysis. But the case becomes involved in still greater ob-
scurity when a body is found dead, without any information as
to the previous sufferings of the individual ; for we are then cut
off from all knowledge of the symptoms, and the means of com-
paring them with the appearances found on dissection ; a most
important help towards arriving at a just conclusion. It is
cases of this latter kind, which place a medical man in the most
trying situation, and demand all the knowledge of toxicology
which he can bring to the task. It behoves him to be well
acquainted with the morbid effects of the different poisons,
and the variations to which these effects are liable, according
to the dose, and the rapidity with which it is followed by death.
Thus, for instance, it is generally known, that one of the usual
effects of the irritant poisons is inflammation of the gastro-
intestinal mucous membrane, terminating in a remarkable
thickening and corrugation of this tunic, the promment parts of
the elevations being of a deep black colour; yet, a person who
would expect to find such appearances in every case of poison-
ing with arsenic, would be very likely to overlook some of the
most important cases of death from that mineral ; there being
‘eases, and these of the most deadly kind, in which little or no
traces of inflammation are to be found in the stomach or intes-
tines.
These observations have suggested themselves in reference
to an important medico-legal case, lately tried in this city, in
which a woman and her paramour were convicted, and executed
for the murder of the husband of the former. The case is im-
portant, inasmuch es conviction was had upon circumstantial
evidence, but that of a nature so clear, that there was no re-
sisting its force.
The unfortunate victim was an elderly delicate man, with a
humped back, named Thomas Canning, who kept a huxter’s
shop in Upper Stephen’s-street, to which he had not removed
many weeks, and was supposed to have about seventy pounds in
Dr. Beatty’s Case of Trial for Poisoning by Arsenic. 205.
the savings’ bank. He had the ground floor of the house, con-
sisting of a small shop in front, and a small room at the back of
it, communicating with the shop by a door, in which room he
and his wife lived and slept. Besides these apartments, they
had another on the first floor, in which they had beds to let
to lodgers. The only lodger they had since they took the con-
cern, was the prisoner Martin, who was a married man, but had
long deserted his wife and children. He had lived with them
in their former lodgings in South King-street for four months. ©
Having, through the kindness of one of the counsel for the
crown, obtained a copy of the depositions sworn to before the
trial, and also his notes of the cross examination of the witnesses
at the trial, I have been enabled, with the help of the reports
given in the public prints. to collect the principal facts, upon
which this extraordinary case rested, and to arrange them in a
connected form.
To take the evidence in chronological order, we have first
the testimony of John Reilly, a police constable, which shews,
that there had been an illicit intercourse between the prisoners,
Maria Canning and Patrick Martin, for a length of time, and
that so far back as the year 1832, they were in the habit of
beating, and otherwise ill-treating the deceased, Thomas Can-
ning. Reilly swore, that in December 1832, Canning came to
the police office to which he is attached, to complain of abuse
and beating by Martin, and his wife, who had been out all
night together. On going to his lodgings, he found there Mar-
tin and Mrs. Canning. Being asked why they abused Can-
ning, Martin denied having done so, but Mrs. Canning ex-
claimed, “a bloody end to the cripple, I will be his end.”
Canning had taken up a poker, to shew witness how his wife
had struck him, when she -ran forward, snatched it out of his
hand, and made a blow at him, which Reilly prevented, by
seizing the poker, and twisting it out of her hand. She then
ran at her husband, and gave him several blows with her fist,
swearing “she would have his life,” that “he was no man.”
206 Dr. Beatty’s Case of Trial for Poisoning by Arsenic.
They were then both held to bail for their good behaviour. Such
scenes were frequently repeated, and the deceased called on
Reilly several times afterwards, to complain of assaults made on
him by the prisoners. The last occasion was so recent as the
7th of January, about a week before his death, when he lodged
informations against Martin; at which time he bore several
marks of violence on his head.
Michael Geoghegan, a lodger in the same house with the
Cannings, stated, that on the 2nd of January last, Mrs. Can-
ning, who had absented herself for three days, returned home.
On this occasion her husband was very angry, and asked her,
“how dare she come back after being out with any fellow,” to
which she only replied in a sneering manner, and asked him for a
glass of spirits. In about an hour afterwards, Geoghegan heard
Martin conversing with Mr. and Mrs. Canning, and they all
three drank together. In some time after, he heard loud snor-
ing in the room, and on looking through a small window in the
door, he saw Canning on the floor asleep, and Mrs. Canning
and Martin standing in the shop, at a press where Canning
kept his bank book, and heard them disputing about eleven
pounds, which she accused him of stealing. He denied it
with dreadful curses, and called her a whore, several times.
She replied, “ you are a gentleman, but if I am a whore to you
itself, you are not to rob us of our hard earnings.” ‘The next
morning, the 3rd of January, they both disappeared ; Mrs.
Canning did not return until the night of Sunday, the 5th Jan-
uary, and Geoghegan heard Martin’s voice in the house the
next morning. Martin was in and out of the house, as a lodger,
from that time until Canning’s death, during which period he
assumed great authority in the house, and frequently used gross
and opprobrious language to Mrs. Canning; who also used
gross epithets to her husband. Early on the morning of Wednes-
day, the 15th of January, the day on which the fatal deed
was committed, Geoghegan heard Canning call his wife down
stairs, from Martin’s room, where she was in bed, and heard
Dr. Beatty’s Case of Trial for Poisoning by Arsenic. 207
her say to him, “ go along, God damn you, or I will knock you
down stairs ;” upon which the deceased retired quietly. This
witness saw Canning in his own room, with his wife, about
seven o'clock in the evening, in his usual health, on his feet, and
sober. From that time until past 12 o’clock at night, when
Canning was found dead, there is no account of what passed in
his room.
Mary Geoghegan, wife of the last witness, deposed, that
about 12 o’clock, on the mght in question, Mrs. Canning came
up to her room, where she was in bed, and gave her a glass of
spirits. Witness shortly afterwards followed her down stairs,
to light a candle, as an excuse to get another glass. When she
got into the deceased’s room, the only persons she saw were the
prisoners. ‘They sent her out for more spirits, of which she
procured. half a pint, and they all sat down to drink it. After
they had drank part of it, Mrs. Canning said, she would give
some of it to her poor Thomas, meaning her husband, who was
lying in the bed, with the curtains close drawn. Martin said,
“hell to him if you do, he will be jawing till morning.” She
said she did not care, she would give him a sup, and rose up
from the table with a heavy sigh, and went over to the bed, but
brought no drink with her. She put her hand into the bed,
and immediately cried out, “he is as cold as clay.” Witness
then took a candle over to the bed, and on drawing the curtain,
found the deceased lying on his back, with all his clothes on,
his cravat tied loosely round his neck, and his mouth wide open.
She at once said he was dead, on which Mrs. Canning observed,
that he was in the habit of sleeping very soundly ; when witness
replied, he was then in the sleep of death. She immediately
Yan up stairs, and awoke her husband, who came down, and
found the deceased as above described. He proposed to go
for Mr. Singleton, a neighbouring apothecary, to which the pri-
soners objected, saying, that as he was dead, there was no use in
making a fuss about it. Nevertheless Mrs. Geoghegan went of
her own accord, and brought Mr. Singleton in with her,
VOL. V. NO. 14. 2 i
208 Dr. Beatty’s Case of Trial for Poisoning by Arsenic.
Mr. Singleton testified, that he was called out by the last
witness, at about half past one o’clock on the morning of the
16th of January, and brought into Canning’s room. He there
found the deceased as already mentioned, and thought he must
have been dead some time. On inquiring as to the cause of
his death, he was told by Martin, that the deceased had been
drinking during the day, that he had lain down on the bed for
some time, being tipsy, and that when they went to awake him,
they found him dead. Witness observed, that if that was the
case, an examination of the body would disclose the cause, and
proposed to have it opened, to which Martin at once said in a
very strong manner, “Oh, Sir, he shall not be opened, we will
not allow it ;” and in such language persevered in his objections,
which created suspicion in the witness’s mind. He asked if
the deceased had made any noise before he died to alarm them,
and was told not. He was not then informed of his having
vomited. Witness then went home, and after he had gone
Mary Geoghegan stripped the body and washed it, in the
presence of the prisoners, and in doing so did not perceive
any thing remarkable on it. Martin then went out for more
spirits, and he and Mrs. Canning continued drinking till
morning ; they drank about a quart altogether. Mr. Singleton
returned at ten o’clock in the morning, and then asked Mrs.
Canning, “what noise was that which your husband made in
his throat when dying ;” to which she replied, “no noise, Sir,
he only complained of a pain in his belly.” Mr. Singleton
then removed the bed clothes, and observed, as he thought, an
appearance of eccymosis on the skin under the clavicles.
Mr. Thomas Weston, shoemaker, the landlord of the house,
but not residing in it, on being informed of Canning’s death,
inquired into the particulars respecting it, and having been
aware of the misconduct of the prisoners, and of their ill treat-
ment of the deceased, he at once declared his suspicion of foul
play, and with a most praiseworthy promptitude, insisted that
an inquest should be held on the body. ‘The inquest was
Dr. Beatty’s Case of Trial for Poisoning by Arsenic. 209
held accordingly in the course of the day, before Alderman
Perrin, one of the city coroners. During the investigation, Mr.
Singleton asked Martin, if the deceased had vomited prior to
his death, who then said he had ; and when Mr. Singleton re-
marked that he had not seen any appearance of it about the
bed, he brought him into the room, and pointed out a wet spot
on the floor, to which Mr. Singleton and Dr. Coote stooped
down and smelled, and thought they perceived a strong smell
of opium.
Dr. Coote opened the body, and stated that he found no
marks of external violence upon it. On opening the stomach,
the villous coat appeared in a state of active inflammation, it
had a corrugated or wrinkled appearance, and he thought it
had lately contained opium, from its strong smell of that drug.
He removed the stomach, with its contents, from the body, put
all up carefully in a bladder, and brought it to me the follow-
ing day.
The evidence which I gave on the trial was to the following
effect. On Friday, the 17th of January, 1834, Dr. Coote, ac-
companied by Mr. Welsh, a medical student, came to my house
and informed me, that he wished to ask my opinion and advice
respecting the stomach of a man, who had died under suspi-
cious circumstances, on the 15th, and whose body he had ex-
amined before the coroner’s jury on the 16th. He produced a
bladder carefully tied up, which he opened in my presence, and
discharged the contents of it, consisting of a human stomach
and heart, into a clean basin. The stomach had been opened
by an incision five inches long, on its anterior surface, near to
the great extremity. Some of the contents escaped into the
basin, but the greater part remained. On examining the
stomach, it was found to contain about half a pint of thick red-
dish coloured fluid, smelling strongly of anniseed, and several
pieces of unchewed half boiled potato. The parietes of the
organ were entire, excepting the incision already mentioned.
‘The mucous lining presented a general red blush, and a minute
210 Dr. Beatty’s Case of Trial for Poisoning by Arsenic.
injection of the small vessels with red blood in several places,
particularly in the great end. It was somewhat thickened, and
some corrugations were evident at the posterior surface. In
some places large patches, some of them of the size of a half
crown, of white matter were found adhering to the mucous
surface. ‘These could be scraped off without difficulty, and
presented the appearance of a fine white powder, mixed up
with mucus into a paste, but the membrane underneath them
did not appear more vascular, or more altered in texture than
in other situations.* On looking at the fluid contents of the
stomach, a similar white powder was perceived floating through
it. The heart was quite healthy.
Having made this cursory examination, I replaced the
stomach, with all its contents, im the bladder, and accompanied
by Dr. Coote and Mr. Welsh, proceeded to my laboratory in
the College of Surgeons. I there, as before, poured the con-
tents of the bladder into a clean basin, and emptied the
stomach entirely, inverting it, to get a clearer view of its inner
coat. [I scraped off a small portion of one of the white patches
which still adhered, with a watch glass, and divided the little
mass into two parts, one of which I transferred to another watch
glass. Into one of these f poured distilled water until it was
nearly full, and on stirring it with a glass rod, the white sub-
stance separated into a powder, which sank to the bottom, and
a viscid substance in which it had been entangled. I now ap-
plied the heat of a spirit lamp, and cautiously boiled ‘the fluid,
by which the powder was dissolved. The clear fluid was now
poured off, and divided into four watch glasses, which I
arranged on a white porcelain slab. Into one of these I drop-
ped cautiously from a tube, the ammoniacal nitrate of silver,
when a copious yellow precipitate took place. Into the second
I dropped the ammoniacal sulphate of copper, which gave an
equally abundant precipitate of a grass green colour. To the
— ns
* The stomach is preserved in the Museum of the College of Surgeons.
Dr. Beatty’s Case of Trial for Poisoning by Arsenic. 211
third I added a little of the hydro-sulphate of ammonia, when
the fluid assumed a deep straw yellow colour, which, on the ad-
dition of a drop of acetic acid, and being gently heated over
the spirit lamp, gave a copious lemon yellow precipitate. To
the fourth a large quantity of lime-water was added, from which
there fell down a white cloudy precipitate. |
Having thus satisfied myself of the presence of arsenious
acid in solution, I proceeded to treat the remaining portion of
the white paste, which I had set aside in its watch glass, by the
reduction process. Previous to doing so, I poured the fluid
contents of the stomach out of the vessel in which it had been
standing, into another, and in the bottom of the former, I per-
ceived some portions of white powder, of which I collected a
few particles on the point of a spatula, and transferred them to
the glass containing the white paste. Having mixed them, I
thought the substance too moist to introduce into the reduction
tube, so I held the glass for a short time over the spirit lamp,
taking care not to apply a heat sufficient to sublime arsenic.
The mass being thus gently dried, was mixed with an equal
portion of black flux, which formed a ball about the size of a
garden pea. I dropped this to the bottom ofa thin glass tube,
six inches long, one-fourth of an inch in diameter, and closed
at the bottom. A paper gutter was now passed down the tube,
and through it a portion of black fiux was poured, so as to
cover the little ball at the bottom ; which done, the gutter was
withdrawn. ‘The part of the tube containing the mass was now
held at a distance over the flame of the spirit lamp, so as to
expel the moisture remaining in the mixture, by a gentle heat.
This rose in vapour, and collected on the inside of the tube,
from whence it was removed by a roll of blotting paper passed
down the tube, and kept revolving between the finger and
thumb, as long as the fluid continued to rise. As soon as this
ceased, the roll of paper was withdrawn. The tube was now
brought nearer to the flame, which was at first directed to the
upper part of the contents, and by degrees the part containing
212 Dr. Beatty’s Case of Trial for Poisoning by Arsenic.
the bulk of the mass was brought into the centre of the flame,
where it was held steady. Ina short time a metallic ring com-
menced to form on the inside of the tube, about a quarter of an
inch above the upper part of the black mass; this gradually
increased in breadth, and at last became a quarter of an inch
broad: a dark coloured ring was formed higher up m the tube,
evidently composed of carbon. The outer surface of the me-
tallic ring, in contact with the glass, was uniformly smooth,
bright, and of the colour of polished steel ; the inner surface
appeared crystalline. This experiment satisfied me that I had
obtained metallic arsenic from the substance treated.
The stomach was now well washed with distilled water, all
the adhering matter was removed, the viscid contents were di-
luted with distilled water, and the whole was introduced into
two flasks, the fluid part into one, and the solid matter, with
some of the fluid, into the other, and set aside for further
analysis.
On the 20th I resumed the investigation. Being anxious to
ascertain the quantity of arsenic contained in the stomach, I pro-
ceeded in the following manner. To the flask containing the
solid matter, six ounces of distilled water were added, and after
acidulating it with acetic acid, it was boiled for a few minutes ; it
was then poured off, leaving the solid matter behind, and filtered
while hot ; a tolerably light clear coloured fluid passed through,
which was collected in a deep, narrow jar, and through it a
stream of sulphuretted hydrogen gas was passed for half an
hour ; this caused a very copious precipitate of a golden yellow”
colour (orpiment): the fluid was now boiled again, which
caused the precipitate to become more distinct, and this was
now separated by filtration and preserved. Tresh distilled wa-
ter was now poured on the solid contents remaining in the flask,
and subjected to the same treatment, by which an abundance
of orpiment was obtained. ‘This process was repeated four times
with the same result, and the whole quantity of orpiment ob-
Dr. Beatty’s Case of Trial for Poisoning by Arsenic. 213
tained weighed, when dry, thirty-one grains, which is equivalent
to twenty-five grains of arsenious acid.*
It having been supposed that laudanum had been adminis-
tered to the deceased, I was desirous of ascertaining whether
any of it could be discovered in the fluid contents of the sto-
mach, which I had set aside in the other flask. Vor this pur-
pose, having consulted with my colleague, Dr. Apjohn, we
agreed that the arsenic contained in solution should be removed
previous to any other steps being taken. Accordingly the fiuid
was removed to a deep narrow jar, and acidulated with acetic
acid ; a stream of sulphuretted hydrogen gas was now passed
through it for an hour, giving rise to an abundant yellow preci-
pitate, which was removed by filtration. The matter caught on
the filter was bulky, and of a less bright colour than that ob-
tained in the former process, owing to the presence of animal
matter, which had not been separated by previous filtration ;
owing to this adulteration of the orpiment I did not preserve it,’
but the quantity was as great as that already obtained. The
fluid which passed through the filter was of a light brown co-
jour, clear, and amounting to eight ounces; this was slowly
evaporated by gentle heat on a sand bath, until the residue be-
came a brown viscid extract, having the appearance and smell
of oymazome. Upon this one ounce of alcohol was digested,
with heat, for five minutes, during which time it was kept stirred
with a glass rod; the alcohol was then poured off into another
dish, and evaporated, leaving a small portion of brownish viscid
matter behind, to which was added one ounce of boiling dis-
_ tilled water, in which the extract readily dissolved.
* The composition of the two substances is as follows :
Arsenic. Oxygen.
Arsenious acid 1 atom 38-4. 14 atoms 12 = 50
Arsenic. Sulphur.
Orpiment 1 atom 38 ++ 14 atoms 24 = 62
Hence sixty-two parts of orpiment are equivalent to fifty parts of arsenious
acid, and consequently thirty-one parts of the former are equivalent to twenty-five
of the latter.
214 Dr. Beatty’s Case of Trial for Poisoning by Arsenic.
This watery solution was now treated with a view to detect
the components of opium, in the following manner :—A small
portion of it was transferred to a watch glass, and some recently
prepared mucilage of starch was well mixed with it, a drop of
iodic acid was let fall into it, when the whole assumed a deep
prussian blue colour.* The remainder of the fluid was then
treated with a solution of acetate of lead, which caused a creamy,
brownish white precipitate. After filtering the fluid, this pre-
cipitate was removed to a watch glass, a little distilled water
was poured over it, and a drop of sulphuric acid was added,
which changed the colour of the precipitate to a perfect white.
This was allowed to subside, and the supernatant fluid was
* This test, which was first proposed by Serullas in the Journal de Chimie et
de Physique, t. xliii., p. 211, has not been taken notice of by English writers, as
far as I know, although it is mentioned by Berzelius, t. v., p. 182, and also in
the Journal de Pharmacie, t. xvi., p. 206. The words of Serullas are these :—
«© Si l'on met en contact ala temperature ordinaire, de l’acide iodique dissous,
avec un seul grain de morphine ou d’acetate de cette base, la liqueur se colore
fortement en rouge brun, et il s’exhale une odour tres vive d’iode: La centiéme
partie d’un grain d’acetate de morphine suffit pour produire cet effet d’une ma-
niere encore tres sensible. L’action est tres prompte, si la liqueur est un peu
concentrée, elle est plus lente quand elle est etendue, mais elle n’est pas moins
appréciable au bout de quelques instans, méme dans sept milles parties d’eau.
La quinine, la cinchonine, la veratrine, la picrotoxine, la narcotine, la strych-
nine, et la bruchine soumises aux memes eprouves, n’agissent aucunement sur
Vacide iodique.
«Pour rendre plus apparent l’iode mis en liberté dans l’experience, on peut
commencer par triturer avec un peu de gelée d’amidon, la petite quantite de
liquide contenant la morphine, ou ses sels, et on y ajoute quelques gouttes de la
dissolution d’acide iodique, qui developpe aussitot la couleur bleue. Ce moyen
peut servir également a reconnaitre opium dans ses preparations, car quelques
gouttes de laudanum ou d’une dissolution aqueuse d’opium mélées a de la colle
d’amidon puis a de la dissolution d’acide iodique donnent aussitot la couleur
bleue.”
It is true that with this test I obtained indication of the presence of morphine,
but having completely failed with all the others, and not having had sufficient
experience of the truth and delicacy of its operation, I was unwilling to place
complete reliance upon the result of the experiment.
Dr. Beatty’s Case of Trial for Poisoning by Arsenic. 215
poured off, to which a drop of permuriate of iron was added,
without any change of colour being effected. The original
fluid from which the brownish white precipitate just men-
tioned had been separated, was now subjected to a stream of
sulphuretted hydrogen gas, with a view to remove any lead
which remained after the first part of the process. The sul-
phuret of lead thus formed was separated by filtration, and to
the fluid which passed through the filter, ammonia was added,
without causing any precipitate. However on being allowed
to stand ina small test tube for twenty-four hours, a minute
quantity of a greyish white deposit was formed, to which, after
the fluid was removed, a drop of permuriate of iron was added,
without causing any change.
From these experiments [ testified at the trial, that arsenic
was contained in the stomach in quantity sufficient to have de-
stroyed life; but I was not able to See respecting the ad-
~ ministration of laudanum.
Mr. Thomas A. Evans, assistant to Mr. Simon Kelly, drug-
gist, No. 64, South Great George’s-street, identified the pri-
soner Martin as having come to the shop on the morning of
Wednesday, the 15th of January, the day of the murder, to
ask the price of forty drops of laudanum. On being told the
price was one penny, he purchased four penny worth, (160
drops,) saying it was for a sick woman in the country. In
about two or three hours, Martin returned to the shop, saying
he had lost, or broken the bottle, and purchased a similar
quantity. On the evening of the same day, he came back, and
asked witness for some poison for rats, when he sold him an
_ ounce of arsenic, having added a few drops of oil of anni-
_ seed to it, to induce the rats to take it. At a later hour on the
same evening, the prisoner again called on witness and said,
“that,” alluding to the arsenic, “had killed five rats,” and he
requested to have a similar quantity, which witness gave him.
Witness identified an empty ounce phial bearing the label of
VOL. v. No. 14. 25 |
216 Dr. Beatty’s Case of Trial for Poisoning by Arsenic.
Mr. Kelly’s shop, and marked “ laudanum,” as one of those in
which he sold that drug to Martin.
It is to be remarked, that Weston, the landlord, and the
‘two Geoghegans, all deposed that they never saw rats im the
house ; neither were there any rat holes to be seen on the pre-
mises.
Catherine Curran stated, that she lived next door to where
{he Cannings resided: between 10 and 11 o’clock, of the
night of the murder, she heard a noise in the back yard like
the falling of a bottle, and on going out, she found a bottle ly-
ing unbroken under the kitchen window, which was the same as
that identified by the last witness.
Jane Mooney, niece to Mrs. Anne Byrne, a publican, living
in South King-street, in whose house the Cannings and Martin
had lodged for four months previous to their removal to Ste-
phen’s-street, stated, that Martin called at the shop on the morn-
ing after Canning’s death, and told her “ the little man was dead,”
meaning Canning: witness asked of what complaint he had
died, when his answer was, that they had all been drinking to-
gether, that the deceased went to bed tipsy, and turned on his
face and was smothered.
Here the case for the prosecution closed. The prisoners
called no witnesses, and counsel made no defence. ‘The jury
retired, and in half an hour brought in a verdict of guilty
against both prisoners.
Here was a case substantiated on as complete a chain of
strong circumstantial evidence, as ever was offered to a jury,—
circumstantial evidence, as the learned judge (Jebb), who
charged the jury, observed, more to be depended on than any
direct evidence could be. The previous long continued adul-
tery of the prisoners ; their constant abuse and ill treatment of
the unfortunate deceased ; the frequent threats of murder made
by his wife; the purchase of a large quantity of poison by Mar-
tin on the very day of the murder; the arsenic being marked
by the oil of anniseed ; the deceased being seen alive and well
in his own room at an early hour of the evening; no one but
Dr. Beatty's Case of Trial for. Poisoning by Arsenic. 217
the prisoners being in his company from that time until his
death ; the conduct of the prisoners at the time of the discovery
of his death ; their refusal to have medical aid called in; and
their refusal to permit an examination of the body when a me-
dical man was brought ; their conduct through. the night after ;
their denial that the deceased had given any warning of his
death, or signs of being ill; and the admission afterwards of
Martin, that he had vomited, and of Mrs. Canning that he had
complained of pain in the belly; the finding of the body on
the back, while Martin stated that he had turned on his face
and smothered ; and, lastly, the finding of about a drachm of
arsenic in the stomach, the contents of which smelled strongly
of anniseed, furnish a connected body of such damning evidence,
as left no doubt on the minds of the jury of the guilt of both.
After the trial I was very desirous of getting some accurate
information from the prisoners respecting the poisoning, and
through the kindness of an official friend, I sent some written
questions to them, which I hoped to have had answered, viz. :
Did Canning get laudanum, if so, when,and how much? How
much arsenic did he get, and how was it administered ? What
effects did it produce ? Did it cause pain or vomiting ; if so, how
soon and how mueh ? When did he die? What symptoms pre-
ceded and attended his death? Was there any violence used
towards him? These were all very important questions, and
satisfactory answers to them would have made this a much more
complete medico-legal document, but I regret to say, that Mar-
tin, who readily confessed his guilt in general terms, refused to
give any particular information. He admitted that the female
culprit was equally guilty with himself in every step; that he
had bought the poison for her, but denied that he had admi-
nistered it. The woman remained obdurate to the last, and
refused to make any confession.
1 proposed the last question, respecting the employment of
violence, in order to satisfy. myself as to the correctness. of a
suggestion I had made to the erown counsel at the trial, viz.
218 Dr. Beatty’s Case of Trial for Poisoning by Arsenic.
that the culprits not finding the poison to act as speedily as they
wished, might have expedited the death of their victim by some
species of smothering or “burking.” Not having seen the
body myself, I was, of course, unable to form any opinion upon
the subject, but an observation of Martin’s, although he would
give no positive information, seems to give a sort of negative
authority for such a supposition, for he gave the gentleman who
questioned him reason to understand, that Canning did not die
of the poison. This is, however, as I have mentioned, but ne-
gative authority for the truth of such a presumption ; and itis a
subject upon which we must now, of course, remain in total
ignorance.
Before I close this account, I think it right to call the at-
tention of the reader to a species of poisoning with arsenic, I
believe not very generally known, and of which the present case
appears to form an example. I say not very generally known,
from having heard some of my brethren express surprise at the
shortness of time (five hours) that intervened, between the see-
ing of Canning alive, and well, and his being found dead. It is
true, that in the majority of cases of poisoning with arsenic, the
time that intervenes between the administration of the dose; and
death, is much longer than in the case before us; it generally
extends from two to three days; but it has been satisfactorily
shewn by Dr. Christison, that under certain circumstances,
death takes place with great rapidity, and is then preceded by
a very different train of symptoms. This chiefly occurs when
the dose has been very large. The signs of inflammation are
far from violent, or altogether wanting, and death takes place in
five or six hours, a period too early for inflammation to be al-
ways properly developed. Vomiting may come on at the usual
time in these cases, but it seldom continues; the most uniform
and remarkable affection is extreme faintness, amounting at
times to deliquium. Dr. Christison mentions eight cases of
this variety of poisoning, to which I beg to refer the reader,*
* On Poisons, section Arsenic.
Dr. Beatty’s Case of Trial for Poisoning by Arsenic. 219
and [ will conclude, by a short abstract of a very remarkable
case of this description, which occurred in this city a few years
ago, and I do so more particularly, because it appears to have
escaped Dr. Christison’s notice.
The case occurred on the 2lst of May, 1828, and is re-
corded by Mr. Wright.* A young woman took an ounce of ar-
senic early in the morning. She suffered little or no pain or
uneasiness for half an hour, when it is supposed she mentioned
the circumstance herself. An apothecary’s lad who then saw
her, administered twenty grains of sulphate of zinc; this pro-
duced vomiting, which was encouraged by tickling the throat
with a feather, and drenching her with warm water and sugar.
This carried up a quantity of white powder, and was continued
until the water came up clear, in which way two gallons of wa-
ter were used. After the lapse of an hour the vomiting re-
curred, producing great exhaustion, which was followed by a
cessation of all the symptoms. At this time Mr. Wright saw
her, and found her perfectly free from all pain, even on pres-
sure, rather drowsy and answering all questions, although not
freely, yet quite collectedly. She was not thirsty, and there
was no fetor of the breath. The pulse was so feeble and rapid,
that it could not be counted, and the surface was bedewed with
a cold clammy sweat. She said she felt exceedingly weak, and
begged to be let alone, and allowed to sleep. In a very short
time she expressed a wish to drink of something warming to her
stomach, when a little peppermint water was given to her, alter
which she fell apparently into a sound sleep, from which she
only awoke in death ; about four hours having elapsed from the
time the dose was swallowed. On dissection, scarcely any ap-
pearance of inflammation was found in the stomach, the only
thing at all to be remarked of that nature, were two very small
vascular spots, and a minute eccymosis, but there were several
large patches of viscid white paste, adhering to the mucous
* Lancet, vol. xvi. p. 612.
220 Dr. Cusack on some Neuralgic Affections.
membrane, from which it could be easily scraped off, leaving
no mark of injury beneath. There were about three pints of a
reddish coloured fluid in the stomach, and in this, flakes of this
white paste were seen floating. On testing the matter just al-
luded to, it was found to be arsenic. This is one of the most
striking cases on record, and it exhibits in strong colours that
variety of poisoning with arsenic, in which its local action is
very trifling, and death is to be attributed entirely to its remote
effects; the organs thus injured are the heart and brain, and the
individual dies in a state of collapse and partial coma. In re-
ference to these cases, Dr. Christison observes, “ they are suffi-
cient to correct an erroneous impression which some entertain,
that arsenic, when it proves fatal, always produces violent and
well marked symptoms.” For further information upon this
important and interesting subject, I must refer to the admirable
work of the author just mentioned.
Arr. XV.—Cases of certain Nervous Diseases, occurring
principally in Females, with Observations. By Samurn
Cusack, A. B. M.B., Surgeon to the United Santry Dis-
pensary, and Wellesley Female Institution, &c. &e.
[Read at a meeting of the Dublin Surgical Society, May 3d, 1833.]
Tue necessity for correctness of diagnosis, in order to the suc-
cessful treatment of disease, is so universally admitted, that
any proof of its importance in the present advanced state of
medical science, may be considered as altogether uncalled for.
While, however, the enlightened physician, by a judi-
cious application of first principles, can in general discriminate
between the most complicated affections, the imexperienced
practitioner, as the following cases fully prove, may fall into
errors calculated to entail on his patients unmanageable ail-
ments, if not irrecoverable disease. My intention, however, on
the present occasion, is not to dwell on diagnosis generally, but
Dr. Cusack on some Neuralgic Affections. 221
to relate some cases illustrative of a peculiar form of nervous*
disease, and to make a few observations on the affections which
those cases exemplify.
~ Case I.—Mrs.
by letter, expressing her desire to be placed under my care dur-
, six months pregnant, consulted me
ing her confinement, which she looked forward to with great
anxiety, having suffered such protracted illness on former occa-
sions, She requested me to prescribe something for a pain in
her right side, from which she was never free, describing it as
being in fgeneral dull, but occasionally most acute and dis-
tressing, shooting through her shoulder.
She had on different occasions applied upwards of two
dozen leeches to her side, used mercury externally, as well as
internally, and was cupped and blistered without obtaining any
relief. The want of success attendant on this plan of treatment,
combined with the description of the symptoms given in the
letter, induced me to consider the affection as one of a nervous
character, and to treat it accordingly. With this view, I directed
a tonic system of living, and prescribed three grains of the pilu-
la hydrargyri, with a similar quantity of the compound galba-
num pill, every third night, to be followed in the morning by a
gentle aperient draught. Four years have since elapsed, and
this lady has been twice confined under my care, and on each
occasion has had as favourable a recovery as I ever witnessed. I
have on different occasions examined the situation of her liver,
and did not find it enlarged or in any way diseased.
She informs me, that the pain (which very rarely troubles
her) always ceases on taking two, or at most three of the pills,
which, to use her own words, act like magic. She does not
take the draught, as it disagreed with her, and did not produce
the intended effect on the bowels. On any return of the pain,
she takes two of the pills at bed time, which have the effect of
Ree gia). 2 We eee ee oe
* The term nervous is made use of in the following communication, in contra-
distinction to organic or inflammatory, and not in any definite sense.
222 Dr. Cusack on some Neuralgic Affections.
gently freeing, and takes a third pill the following night, if the
pain continues, but never finds it necessary to take a fourth.
It is worth remarking, that a few days after each of her last
two confinements, on feeling the pain, she asked leave to take
the pills, and on doing so, the pain immediately ceased. Had
she, instead of using these simple remedies, been subjected to
as rigorous treatment, as on former occasions, might not a re-
currence of her former sufferings have been the result ?
Mrs. ——_—— requested me to prescribe for one of her
domestics, whom she apprehended was becoming consumptive.
She had nursed a child for her mistress about three years pre-
viously, and for some time after enjoyed very good health; lat-
terly, however, she has lost all relish for food, become com-
pletely incapable of any exertion, and has fallen. quite into a
state of despondency. She never stirs outside the house, and
from a pain in her right side, and constant palpitation, she
looks upon her condition as completely hopeless. In reply to
my inquiries as to her habits, and the remedies that had been
used for her relief, she informed me, that tea constituted al-
most her entire sustenance, and that leeches had been applied
to her side, which had the effect of weakening, but not relieving
her.
Notwithstanding her delicate condition, having satisfied my-
self that no organic disease existed, I gave an encouraging
prognosis, and I assured her, that her health would in all pro-
bability be completely restored by a strict adherence to my
directions, which were, strict inhibition of tea or coffee, regular
exercise of a gentle kind, attention to the temperature of the
lower extremities, and the use of the following remedies ;
R. Masse Pilule Galbani Comp. gr. vil.
Hydrarg yrds ore tll.
Fiant pilulee due, 3a. q. q. nocte sumend.
kK. Infusi Quassiee, 3 xii.
Sulphatis Magnesiz, 3iss.
Fiat haustus, 3a. q. q. mane sumendus.
Dr. Cusack on some Neuralgic Affections. 223
After some weeks she was much improved, and at the ex-
piration of a year, I had an opportunity of seeing her com-
pletely restored to health.
Mrs. M , etat. 29, wife to a police constable, has had
pain for some time in situation of liver, with palpitation; this
was completely relieved under the use of powders of carbonate
of iron, and valerian, she had tried different other medicines,
ineffectually.
Mrs. » tat. 30, the mother of several children, has
been subject for many years to a distressing pain of the right
side, between false ribs and crista of ilium, she is also teased
with frequent headach. When the pain was very severe, it
completely disappeared on taking ten grains of carbonate of iron,
a scruple of valerian, and five grains of effloresced soda, three
times a day, and applying to the side the aromatic plaster of
the Dublin College. This lady, from her mode of life, has oc-
casional returns of the pain, and always derives the greatest
benefit from taking a combination of compound galbanum and
blue pill, and draughts of compound infusion of gentian, tincture
of rhubarb, and sulphate of magnesia. She has used aloetic
purgatives in other forms, and pills of aloes, assafoetida, and
sulphate of iron, without any benefit.
Judy Cloony, dispensary patient, a person of intemperate
habits, has suffered for the last two years intense pain to the
right of the spine, between the false ribs and crista of the
ihum. It is at present so acute, that she walks nearly doubled ;
she was bled and blistered when the pain commenced, without
any diminution of pain. Finding that no relief was obtained
by purgatives, and terebinthinate frictions, which I had often
_ found serviceable in such cases, I directed a tea spoonful of
acetate of iron, (the only preparation I had at the time), every
second hour, desiring it to be discontinued if any unpleasant
effect was produced. After using the quantity I gave her, (one
ounce), she told me she felt more relief than she had ever be:
fore experienced: I then directed fifty drops of the muriated
VOL. Vv. No. 14, 26
224 Dr. Cusack on some Neuralgic Affections.
tincture of iron, in a wine glassful of infusion of valerian, three
times a day, under which treatment the pain completely disap-
peared, and has not since returned.
Mary H
of some months’ duration, took an aperient pill daily, and, sub-
, etat. 14, for the relief of a severe headach
sequently, had two issues opened on the top of her head, which
were kept discharging for a considerable time by means of
caustic applications. Much suffering and debility ensued, but
no diminution of headach ; latterly, the issues have been allowed
to heal, the headach, however, still continues. She has never
menstruated, is subject to chronic bronchitis, and frequently
distressed with flatulence; her appetite is bad, her extremities
cold, she leads a sedentary life, and makes use of tea twice
aday. I treated this individual, by ordering the use of light
animal food ; and by inhibiting the tea, and insisting on exer-
cise in the open air. Small doses of blue pill, with the com-
pound galbanum pill, with an infusion of quassia with sulphate of
magnesia, were directed to be taken every third day, ordering,
in addition, the pediluvium; and in the progress of the case, I
substituted a mixture composed of equal parts of the infusions
valerian and quassia for the other medicines: under this treat-
ment she has perfectly recovered. The catamenia did not ap-
pear for a considerable period alter, notwithstanding the com-
plete removal of all unfavourable symptoms. |
The foregoing cases, selected from amongst many others of
asimilar nature, seem to be of considerable interest in a practical
point of view. They exemplify diseases of a nervous charac-
ter, in a great measure amenable to treatment of a mild nature,
but aggravated, if not rendered altogether incurable by severe
measures, which impair the peculiar constitutions, in which
those diseases are found to exist. On reference to the cases, it
will appear, that three similar forms of disease exist, occupying
different situations, and requiring with some a similar plan of
treatment. It will also be seen, that those affections, when
Dr. Cusack on some Neuralgic Affections. 220
their true character is not known, are liable to be mistaken for
inflammations of some contiguous viscus, and treated as such.
The first of those affections which we shall consider are,
what we shall term the hypochondriac pains, from their situa-
tion, one having its seat in the right, the other in the left hypo-
chondriac region. The former of these pains is frequently con-
sidered indicative of inflammation, or disease of the liver, and
treated by bleeding, leeching, mercury, purgatives, &c.* The
left hypochondriac pain the author has seen treated as inflamma-
tion of the pleura. The situation of these pains is not uniform.
In some instances they are felt inferior to the mammz on the
convex part of the ribs, sometimes they are situated immediately
below the false ribs, or midway between them and the crista
of the ilium, occasionally to the corresponding shoulder, hip,
and thigh, or shoot across from the spine to sternum, as if tra-
versing the diaphragm: not unfrequently the right and left hy-
pochondriac pains are found to alternate with each other. ‘These
pains are in general of an obtuse character, but liable to dis-
tressing exacerbations, there is frequently great uneasiness pro-
duced by pressure, or even touching the integuments, this
seems, however, to be the result of mere morbid sensibility of
the part.
The third form of the disease is the pain of the head, or
cephalic pain, which, like the hypochondriac pains, is not uni-
form as to situation or extent. It is sometimes confined to a
small spot near the orbit or vertex, and sometimes spreads over
the entire head. From the description given to the author of,
this affection, in many instances it did not appear to him to be
so much a pain, but rathera kind of morbid feeling or sensibi-
lity carried to a high degree. In the cases which the author
witnessed, there was not any unusual state of vision attendant
* A case illustrative of this affection is alluded to by Dr. W. Stokes, in his
able paper on Inflammation of the Liver, in the Cyclopedia of Medicine, and
Andral’s opinion quoted on the subject.
Dr. Cusack on some Neuralgic Affections.
on the pain. Many persons labouring under this affection, ex-
perienced a sensation as if the hair was dragging out by the
roots, and not unfrequently complained of intense cold of the
head, and a feeling as if cold water was pouring on it. In such
eases it is not unusual to heap flannel caps on the head, a pro-
ceeding which aggravates the disease. With respect to the
precise seat of those affections, or as to whether any appreciable
change is produced in the internal organization of the part en-
gaged, an opinion can only be formed from conjecture, as pa-
thology does not throw any light on the subject. It seems
probable, however, from the fact of all those affections being
found to alternate, and even sometimes to co-exist in the same
individual, as well as from the similarity of the hypochondriac
pains of either side, that their seat is in the more superficial
parts of the body, and not in the contiguous viscera.
The diagnosis of those affections is not to be formed without
a familiar acquaintance with the symptoms of the diseases which
they simulate; mdependently, however, of the aid afforded us
by a comparison of symptoms, some collateral circumstances
may give us much assistance in determining our diagnosis ; for
instance, the comparative frequency of those affections, and the
diseases which they simulate. The affections under considera-
tion are of frequent occurrence, the diseases which they simu-
late comparatively rare. Secondly, should the diseases have
been of long continuance ; the effect of former treatment. Thus
if those affections have been aggravated, or not alleviated, by
an antiphlogistic plan of treatment, it will tend to shew that
their character is not inflammatory. We must, however, bear
in mind, that treatment, which in reality is injudicious, may oc-
casionally give temporary relief; for instanee, those pains will
occasionally be lessened by the application of leeches, a cireum-
stance to be accounted for by the inexplicable fact, that nervous
pains can, in many instances, be relieved by the development of
a new action. Leeching, however, though in some. instances
capable of producing this effect, is calculated, if carried too far,
Dr. Cusack on some Neuralgic Affections. 227
A!
to induce that peculiar state of the constitution, favourable to
the development of those diseases. Thirdly, the sex of the
patient. Females are far more liable to those affections than
males, though the latter sex is by no means exempt. Fourthly,
the constitution of the person affected, It is in persons of a
nervous, hypochondriac, and dyspeptic constitution that those
ailments are found most frequently to exist. Lastly, much assist-
ance in forming a diagnosis is to be derived from the habits of
the patient and mode of life ; should a female, who is constantly
confined to the house at her needle, as milliners in large cities
frequently are, who drink a large quantity of tea, and have no
relish for other food, complain of pain in the situations we have
been describing, we may, without further hesitation, rank the dis-
ease in the class under consideration. ‘Two circumstances, howe-
ver, should never be lost sight of in the diagnosis of those affec-
tions, first, that a person affected with those nervous diseases is by
no means exempt from the existence of disease of a more danger-
ous description: an individual, such as we have been describing,
may, in the first instance, labour under any of those affections, es-
pecially the hypochondriac pains, and may, if injudiciously treat-
ed, particularly if she be of a scrofulous diathesis, ultimately fall a
victim to phthisis : secondly, any of those pains (though to the per-
son affected apparently uniform) may arise from different causes,
be totally dissimilar in their nature, and necessarily require quite
an opposite system of treatment. Thus the hypochondriac pains
may at one time be neuralgic, and at another time be indicative
of inflammation of the stomach or duodenum, or of the pleura :
in like manner we find that headach may in the same person be
at one time the result of plethora or inflammation, and subse-
quently, without any intermission, assume the nervous character
we have been describing.* This appears to us to be a most
gee Seo el is ol er ea titel oles if Asi inf
* We conceive, however, that acute pain of the head, or of the hypochondriac
regions, is less likely to be inflammatory, when pain in those situations has pre-
viously existed in its nervous form,
228 Dr. Cusack on some Neuralgic Affections.
important point of consideration in the treatment of cephalic
affections, that a headach may, in the first instance, be inflam-
matory, and without any interval, during which the patient is
free from pain, run into one of quite an opposite kind. We re-
cently attended a lady who laboured under intense headach,
accompanied by great determination of blood to the head; it
was lessened by the. application of a large number of leeches.
The relief afforded was not of long continuance, and the lady,
judging by her own feelings, requested that the leeches might
be re-applied. Being fully persuaded, however, that the cha-
racter of the headach was altered, we prescribed musk, vale-
rian, and Dover’s powders in large quantities, and the result
fully answered our expectations.
It is not our intention to enter at any length into the considera-
tion of the treatment of those affections, as the cases which have
been related, in a great measure exemplify what we have to offer
on that subject. We believea removal of the exciting causes is,
in many instances, sufficient for the cure of the disease, and im
any instance of disease, without such removal, all other treatment
must be ineffectual. Thus if we find that sedentary habits induce
those diseases, exercise is to be enjoined. The nature and de-
gree of exercise must, of course, be suited to the individual
case, and will evidently defeat the object in view, if carried so
far as to produce fatigue; sometimes walking, at other times
horse or carriage exercise will be found most beneficial.
When we are prescribing for young females in the higher
classes of society, we should bear in recollection, that in many
snstances so much time is devoted to study and the acquirement
of what are termed accomplishments, that the health is often
sacrificed thereto. The headach we have described is fre-
quently aggravated, if not entirely caused by the quantity of
hair worn by some females; when such is the case, the hair
should be cut close, and a light cap worn. The feet of indivi-
duals, subject to the pains we have been describing, are, in ge-
neral, uncomfortably cold ; every means should be employed to
Dr. Cusack on some Neuralgic Affections. 229
preserve a natural temperature, and immersion in warm water
every second night, or oftener, with subsequent friction, by
means of a towel wrung out of salt water and dried, or a flesh
brush, will be found most serviceable. In many instances those
affections are entirely attributable to the use of tea: this is par-
ticularly the case amongst females in the lower ranks of life,
who render this beverage less wholesome as well as palatable
by boiling instead of infusing it, and frequently live almost en-
tirely on this fluid. Where tea is found to produce this effect,
its use should be interdicted, and cocoa, whey, or some other drink
substituted. Coffee will frequently be found to produce the same
unpleasant effects as tea; where such is the case, a very weak
infusion of the burned roots of the wild succory or chicory, with
a large proportion of boiled milk or cream, will be found an
agreeable and wholesome substitute.
Attention to diet must evidently be of paramount import-
ance. The kind of food, however, that is found to agree with
the class of patients we have to treat, is so well known that it
is unnecessary to dwell thereon; we shall, therefore, be content
with giving the caution of not using solid or stimulating food in
cases where the hypochondriac pains are the product of inflam-
mation, as much aggravation of inflammation and pain must be
the result.* The medicines serviceable in the diseases under
consideration are such as improve the state of the digestive
system and the general health; subdue nervous irritability, and
relieve pain. And in many instances, those remedies will be
found more useful when employed conjointly. Without wish-
ing to attach undue importance to any one remedy, we would
* Females of a weakly, nervous, constitution, often find a degree of temporary
benefit from the use of wine. Its effect, however, is but temporary, and after the
excitement produced by it is over, an aggravation of the. nervous symptoms is al-
most always the result. _We should carefully avoid allowing such patients to
acquire the habit of using unnecessarily ether, ammonia, and such like stimu-
Jants.
230 Dr. Cusack on some Neuralgic Affections.
mention what in our practice has been found most frequently
useful, namely, small doses of the pilule hydrargyri alone, or
combined with one or two parts of the compound galbanum pill,
every second or third night, followed in the morning by
draughts of infusion of quassia, holding a small quantity of
sulphate of magnesia in solution: we have found this combina-
tion so frequently beneficial, that we would have recourse to it
in preference to any other remedy, where there was no circum-
stance to contra-indicate its use. The infusion of quassia, com-
bined with the tinctures of rhubarb, gentian, or columbo, have
in many instances proved serviceable. In some rare cases,
where those remedies failed in giving relief, we have seen be-
nefit arise from the employment of active purgatives, as jalap
and calomel, the compound colocynth pill, with calomel, &c.
In some few instances, where the pain of the left side was so
acute as to resemble inflammation, and the patient had solicited
us to use the lancet, we have completely relieved the pain by
active purgatives.
We have frequently found the chalybeate preparations
of the greatest benefit; the preparations which we most generally
employed were the carbonate of iron, in the proportion of ten
grains, with a scruple of valerian, and ten grains of dried soda
in syrup of ginger, three times a day. We have also used the
muriated tincture of iron, and acetate of iron, in draughts of
infusion of valerian, or infusion of quassia combined with tinc-
ture of colombo. As to local treatment, we have not found
any benefit from the application of leeches, except in the hypo-
chondriac pains, when resulting from inflammation, in which
case the application of leeches, or cupping, should invariably
be had recourse to. We are unable to speak from personal
experience of the application of tartar emetic ointment or blisters.
In the cases where we witnessed their employment, they seemed
only to increase the sufferings of the patient. We have, however,
seen the greatest benefit apparently arise in the hypochondriac
affections from the application of the aromatic plaster, and have
Dr. Cusack on some Neuralgic Affections. 231
been informed by others of its beneficial results.* The greatest
relief has almost invariably been derived by the persons under
our care affected with the cephalic pain from the employment
of the popular remedy, valerian. This we have exhibited in
the form of infusion alone, or combined with the simple or vo-
latile tincture and syrup of ginger. In many cases. of this
pain, with great disturbance of the nervous. system, we have
found half a drachm of the volatile tincture of valerian produce
the most refreshing sleep.
In conclusion, we trust, from the cases related, that it will
appear that those troublesome affections which form the sub-
ject of the present communication, are in all instances capable
of considerable alleviation, and in many of perfect cure. While
in most instances a glance of the experienced eye is suffi-
cient to recognize those diseases, we must confess that there
have been instances where we have been in doubt to what class
of disease those cases were referrible. Such instances, how-
ever, were but rare, and we never have had reason to regret
adhering to the following rule of practice. If in the event of
the diseases being inflammatory, procrastination would possibly
have been of serious consequence, we have run the risk of
erring on the safe side, and treated the diseases as if they were
inflammatory ; and where there was no circumstance to contra-
indicate it, we have, in conjunction with antiphlogistic mea-
sures, employed such means as would be calculated to relieve
the disease if of a nervous character. Where, however, there
was a strong probability, but not a certainty, of the disease
being nervous, and no danger to be dreaded from delay, we
treated it as nervous, watching most closely the effect of our re-
* We are not aware whether a pain of the left side alluded to in the. article
Hysteria, in the Cyclopedia of Practical Medicine, is the same as that we have.
been considering. If so, we have been more fortunate in the cases we have had
to deai with than the author of that paper, as he has found the pain most un-
manageable, The reverse has been the result with us.
VOL. Vv. NO. 14. 2H
232 Dr. Morgan’s Pathological Researches.
medies, to be ready, if necessary, to resort to measures of quite
an opposite. character.
Te es Le gS a
Art. XVL—Pathological Researches.—Inflammatory Affec-
tions of the Brain, and its investing Membranes.—By
W. I. Moraan, A. M. M. D., Vice-President, and One of
the Censors of the King and Queen’s College of Physi-
cians. Physician to the Whitworth Hospital, &c.
Tue practice of the physician frequently presents to him cases
fraught with interest and instruction, but which, in general, fade
from his memory, and become lost both to him and the profes-
sion, unless he may have some favourite theory to support, or
point of practice to illustrate ; and then, the details appear un-
der circumstances at least open to suspicion, and must come
shorn of half their value, when those of successful issue alone are
introduced. It has jong been my opinion, that a simple, faith-
ful portraiture of diseases as they appeared at the bed-side of
the patient, as closely copied from nature as fallible judgment,
and the defective medium by which we must convey them, can
depict, together with a record of the treatment and its result,
without, however, any intentionally direct reference to particular
views either of theory or practice, would contribute more to the
improvement and stability of medicine, than all the fine-spun
theories, which have so long served to gratify the “ construc-
tiveness” of ingenious inventors, and disappoint the hopes of
the sober practitioner. From cases in which our endeavours
have been crowned with success, much may undoubtedly be
learned; yet there are others of still higher importance to the
profession; I mean those in which, after all our science, and all
our skill have been put forth in vain, the cause of failure
has been detected by an examination of the diseased parts,
after death. How few, comparatively, of such cases are to be
found on record! Much, however, as we may regret the cireum-
Dr. Morgan’s Pathological Researches. 233
stance, we cannot be surprised at the fact. The publication of
sticcessful cases has much in itself which is grateful, and nothing
repulsive to our vanity, self-esteem, and love of reputation: on
the other hand, there is something humiliating in recording our
own defeat, subjecting our opinions to public scrutiny, and
bringing our professional judgment to the palpable test of post
mortem examination. Would that this were all! There is
something still more galling to be feared. The love for Science
is not yet, among all the members of our profession, so purely
platonic, as to induce them to court her for her own sake alone.
An inviting opportunity of raising our fame on the ruin of that
of our neighbour; of exalting our self-complacency at the ex-
pense of his feelings and reputation ; of blasting all that is dear
to him with a sarcastic sneer—indicative of the much we could say,
if we gave utterance to all our weighty animadversions—these,
and much more, all equally at variance with professions of fidelity
to her service, or attachment to her culture, are not considered in-
compatible by those who profess to be her votaries. What gene-
rous mind would subject itself to such a return for faithful services
performed? Who would voluntarily submit to be dragged forth as
a culprit to the bar of public opinion, to hear his own candour
converted into subject-matter of accusation; to be twitted on
account of supposed ignorance, and have his own very concessions
cast in his teeth? The man who has the honest boldness to give
to the profession a faithful history of unsuccessful cases, must be
impelled by some good motive, and should be protected by
every friend to science, to honour, and to humanity, not merely
from the captious objector, but from those also, who, however
well-meaning, judge and pass sentence without reflecting, that
the candour of the writer has placed them in circumstances
_ widely differing from those which he himself had occupied, as
the practitioner. No doubt, no difficulty, no obscurity clouds
the reader’s view. He can see the event from the beginning ;
glance in one moment, from the first premonitory symptom, to
the morbid appearances found on dissection, and then, return
234 Dr. Morgan’s Pathological Researches.
again with a mind instructed in the nature and the result of tlie
disease, qualified to scrutinize every progressive step in the
treatment, and to form a very close estimate of the correctness
of the views by which those measures were dictated—advan-
tages, it should be remembered, which the practitioner never
enjoyed.
Having accustomed myself, during some years, to premise
my daily prescriptions with a short but accurate sketch of the
most prominent symptoms of my patients, as I stood by their
beds in the hospital, and occasionally to note those also in pri-
vate practice, after retiring from the sick room, I determined,
at some time, to give these sketches to the profession as public
property ; yet that time might never have arrived, but for the
recent observations on the cases published by an eminent surgeon
of this city. I could not avoid reflecting, that few seem to be
aware how insidious and treacherous inflammatory affections of
the brain and its investing membranes may be. ‘The very men-
tion of such affections is associated in our minds with the pre-
sence of great constitutional disturbance, high mental excite-
ment, or its very opposite, total insensibility—in fact, with phe-
nomena, so obvious and so permanent, that they could not fail
to arrest attention and excite apprehension: yet these pheno-
mena may be absent, or so indistinct and so fugitive as to be
of no practical benefit. I do not mean to say that we shall not
find symptoms to guide us in our practice, and to premonish
us of the result; but this I assert, that cases occur in which the
symptoms are by no means adequately indicative of the urgency
of the disease, and that, without a caution and circumspection,
for which we are not always prepared, the most experienced
may occasionally find that he had been indulging a false se-
curity.
Possessing the particulars of a case, interesting in itself, and
in many points similar to the first of those given by the talented
individual to whom I have alluded, it appeared to me that
some further illustration might be afforded by its publication,
. Dr. Morgan’s Pathological Researches. 230
and that I ought not longer to postpone my determination. My
object, then, in these preliminary observations, is to explain my
motives and intentions, and to bespeak from my readers some
little patience and forbearance.
On the accumulated knowledge of physiological and patho-
logical facts, the improvement of medicine, as a science, must
mainly depend: the very error, under the oppressive effects of
which our profession has been so long struggling, was too hasty
generalization. Into the truth of facts, therefore, or whatever
comes to us professing to be such, a scrutiny can never be too
severely instituted, but in the very exercise of the most critical
scepticism, the most rigorous investigation, we should still bear
in mind, that between the “suaviter in modo,” and the “ fortiter
in re,” there is nothing essentially inconsistent.
On perusing the case which I shall now submit, as the
first of my promised series, and which I shall copy as it
was recorded nearly four years since, I do not feel that I have
much on account of which to accuse myself; yet, though the in-
stability of the symptoms kept me in painful suspense, as to the
progress and event of the disease, I freely confess that I did not
anticipate the sudden demise of my patient, nor expect to find
one hemisphere of the brain nearly bathed in purulent matter,
and a portion of the dura mater detached from the temporal
bone. But the case shall speak for itself.
Case I.—Mr. eet. 24, was admitted as a fever pa-
tient to the private ward in the Whitworth Hospital, Royal Canal,
on the 24th of August, 1830.
Report.—Three weeks since caught cold, followed by ex-
tremely severe pain in left ear, pulsating and extending to left
frontal region. Has been increasingly worse during this period
till to-day, when he feels himself better. No discharge from,
nor apparent inflammation of, external ear: has taken much
purgative medicine. Was under the care of Mr , apo-
thecary. Had been blistered behind ear. Pulse 104, soft;
tongue white in centre; skin warm. Has taken two pills this
morning.
236 Dr. Morgan’s Pathological Researches.
R. Carb. Sod Zss.
Sacch. Albi 31.
Solutionis Antimonii ss.
Tincturse Opi, gutt. xx.
Aquze Fontanez, Zviiss. 1.
St. coch. duo cum uno succi limonis inter effm. 2d4 quaque hora.
N.B. Should the pain of ear return in the evening, six leeches
should be applied in its neighbourhood, followed by a bread and milk
poultice over the ear, when the leeches fall off.
25th. Leeches and poultice applied. Very little relieved
by means adopted yesterday. Obliged to have an anodyne* in
the night. Bowels not free. Tongue loaded at root. Pulse
80, bounding. Profuse perspiration during night. Pain ex-
tends from left ear over left frontal region ; increased on pres-
sure. Inflammation of conjunctiva of left eye.
Mittantur Sanguinis ex Arteria Temporali uncize decem.
Bol. Purg. (Subm. Hydrarg. gr. v. Puly. Jalapze, gr. xv.) q. p-
Mist. Purg. vesperi, si opus sit.
26th. Slept well during night. Much relieved till half past
twelve to-day, when he was suddenly seized with excruciating
pain of ear, screeching and delirium. Is still delirious. Words
incoherent, and like a foreign language. Pulse 96, full : skin
hot: trembles and complains of chilliness: tongue moist,
slightly white: bowels well freed: pain not so great.
-T
a te
Mittantur sanguinis e Brachio unciz
* For this practice, whether right or wrong, I am not accountable, as it was
adopted by the resident apothecary, on his own judgment and responsibility. I
am aware that some are averse to the use of any portion of opium in head affections ;
put our judgments on this, as perhaps on other points of practice, may be preju-
diced by what we have witnessed in a few instances ; some patients being as re-
markably susceptible of the bad effects of opium, without any of the good, as others
are of being benefited by all the good, without experiencing any of the bad.
+ Thus it is written in my prescription book ; for I had given a verbal order
to measure the blood drawn, not by quantity, but by effects, and to allow it to
flow as copiously as the strength of the patient would permit. I regret, merely as
a matter of curiosity, that I have no record of the amount taken on this occasion.
Dr. Morgan’s Pathological Researches. 237
K. Submuriatis Hydrargyri grana quindecim.
Pulveris Antimonialis grana sex.
Opii granum.
Ft. pilule sex. Sumat unam hora omni altera. Foveantur pe-
des vesperi.
27th. Very much relieved. Says he suffers no pain. Quite
composed. Face flushed. Pulse 80, soft: skin moist: tongue
white : no stool.
K. Sulphatis Magnesiz 3xil.
Tart. Antimon. grani dimidium.
Aque Font. 2 viiss.
Tincturee Jalapze, Zss. m.-
Ft. mistura cujus sumat coch. duo, hora omni, donec alvus soluta
sit.
Enema Purg. vesperi.
28th. Was very well till half past ten o’clock last night,
when pain suddenly seized him in the ear again ; since which
has been affected as on 26th. Complains much of pain in small
of back. Head now hot: pulse 80, full and hard: tongue
white and loaded : bowels smartly freed during night : speech
incoherent : pain of ear not urgent now.
V.S. ad Zxii.
App. Emp. Canth. Nuche.
kk. Masse Pilulee Hydrargyri, gr. xv.
Tartari Antimonii granum.
Opii grana duo.
Ft. Pilule sex. Sumat unam hora omni alterd.
N. B. If pain of head should continue after venesection, let
twelve leeches be appled to temples.
29th. Pain allayed. Says it is often absent for six or eight
hours. Pulse 96, not very sharp. Tongue loaded and white.
Bowels well freed. 'Tenesmus. Much general tremor. Head
very hot. No external marks of inflammation. Mind quite
sensible. | :
Applicentur Hirudines duodecim temporibus.
238 Dr. Morgan’s Pathological Researches.
BR. Hydrargyri cum Creta grana decem.
Divide in partes sex. Sumat unam 3tid qudque hora.
Haust. Olei Ricini primo mane.
30th August.—Died at six o’clock this morning.
He had been rather easier during the night, and until this
moming, when he complained of a sense of suffocation ; was
raised up at his own request ; spoke intelligibly ; said he felt
faintish ; was laid down, and soon expired.
Autopsia, thirty Hours after Death.—Present, Doctor ——,
the cousin of the deceased ; Robert Adams, Esq., A. M., the Sur-
geon to the hospital ; and Dr. Robinson, one of the Physicians to
the Fever Hospital, Cork-street, a casual visitor. ‘The dura
mater, which presented nothing remarkable, having been
removed, the brain was found firm, and, when cut into, its
medullary substance was a little more vascular than natural.
That portion of the brain which corresponded to the region
supported by the temporal bone, was covered by a layer of
yellowish-green puriform lymph. This lymph was visible through
the transparent arachnoid membrane which covered it, and ap-
peared to be partially spread over the convolutions of the
brain, sinking into their sulci,—in short, it was infiltrated into
the spaces between the arachnoid and pia mater of the left
temporal region of the brain.
The inflammatory irritation which had produced this im-
perfectly formed lymph, had not confined itself to the exterior
membranes, for the arachnoid-lining of the ventricles, as well
as the spinal arachnoid, had produced a quantity of clear
serum, which flowed out when the ventricles and spinal canal
were laid open.
As the paroxysms of pain had been referred to the ear,
during the few days he was under my observation, we next
directed our attention to this organ. In the external ear and
meatus, nothing unusual could be discovered; but when the
CO
Dr. Morgan’s Pathological Researches. 2s
left hemisphere and middle lobe of the brain had been fully
raised up from the petrous portion of the temporal bone, a thick
bed of yellow lymph was found, intervening between the anterior
surface of this part of the cranium and its proper covering, the
dura mater. This latter was separated here for the space of half
an inch square, from that part of the temporal bone which over-
hangs the roof of the labyrinth of the internal ear. This part
_ of the petrous bone was somewhat softened, as it admitted the
knife, with some little pressure, to sink into it.
The state of the petrous bone, already described, and the
separation of its periostial, or dura-matral,. covering, by a
thick bed of yellow lymph ; secondly, the puriform effusion, or
infiltration of lymph, underneath the arachnoid of the left he-
misphere ; thirdly, the serous effusion into the interior of the
ventricles and spinal. canal, with some increase of the vascu-
larity of the brain, were the morbid phenomena detected on ex-
amination, whence originated these variable but insidious symp-
toms, and which finally terminated in the death of this gentle-
man. |
I shall now subjoin a few observations on the more remark-
able features of this case. This disease must have been most in-
sidious from the very commencement : for, first, the apothecary,
who had been attending the patient for three weeks previously to
his admission, never adopted more active measures than cathar-
tics and a blister behind the ear, and at the end of that time
sent him to me asa fever patient. Secondly, his cousin, who
is a physician in good practice in a branch of our profession,
in this city, and who visited him, gave him in charge to me
without expressing his dissent from the opinion delivered by
the apothecary. Thirdly, when I saw him, no pain, nor any
other symptom, indicative of the real seat of the complaint, was
present, and the first day’s’ record is occupied chiefly with the
detail of past, rather than present symptoms. Fourthly, dur-
ing an attendance of five days I never saw him in a paroxysm of
pain: once only, viz. on the 26th, witnessed the effeets produced
VOL. V. No. 14. 2
240 Dr. Morgan’s Pathological Researches.
by it, and it was in reference to this fact,—the absence of pain,
that, but a few hours before his death, I obtained the remark-
able answer recorded under that date as to his freedom from
pain, and the duration of its absence. Fifthly, whatever he
may have suffered during the presence of pain, he had perfect
intermissions, and at each return it observed a certain period of
aggression: both of which symptoms were formerly assumed as the
distinctive marks by which the presence of inflammation might
be negatived. Sixthly, as such extensive morbid changes could
not have taken place either at or after his decease, they must
have commenced and progressively advanced, perhaps from ar
early period of the attack: yet we have already seen that he
had intervals of perfect immunity from every urgent symptom ;
lastly, at the very moment of time when those changes had
arrived at their full amount, and in so much that they ceased
to be longer compatible with life, his mind was in perfect en-
joyment of intelligence, and neither delirium, nor coma, nor
convulsions, announced the affection of the brain or of its mem-
branes. Perhaps it is my duty to add, that subsequently to the
decease of my patient, I learned, on good authority, that this
fatal attack was attributed to imprudent exposure to cold by
bathing in the sea, too soon after the employment of mercury
in the removal of syphilis.
Within the last two months I have witnessed another case,
which, though not so mteresting in detail, is equally illustrative
of the fact, that inflammatory action may commence, proceed,
and terminate in the formation of purulent matter, in the mem-
branes of the brain, without exciting any of those symptoms by
which we could pronounce that such a formidable process had
been established there. I shall condense the report as mucly
as possible. |
Case IJ.—Sarah Johnstone, etat. above 60, had been under
medical treatment on account of cough and difficult respira-
tion, the effects of catarrh originating im exposure to wet, six
days previously to her admissicn into the hospital.
Dr. Morgan’s Pathological Researches. 241
When she came under my care, 16th December, 1833, her
most urgent symptoms were pain in epigastrium ‘and right hy-
pochondrium, and obstinately constipated bowels, but which
yielded to the application of eight leeches to right hypochon-
drium, and a blister to epigastrium, accompanied by the steady
exhibition of mild purgatives, which succeeded on the third day
in bringing off copious ‘hard, dark stools. Pulse 100-112.
Tongue loaded. Her strength appeared to be so broken, ‘that
from the second day, the citrate of ammonia, with camphor mix-
ture, were directed for her. On the fifth day from her admis-
sion, an alarming prostration of strength suddenly supervened.
No active nor debilitating measures had been employed, by
which to account for this sudden collapse. Yet her pulse was in-
distinct, and stools passed involuntarily. Re-action commenced
onthe seventh day. Her pulse became distinct, at seventy-five.
Tongue clean: heat of surface returned: symptoms remaining
stationary till the eleventh day, when the eyelids became tumid :
tongue covered with dark sordes: pulse seventy, and feeble. At
this period erysipelatous inflammation suddenly appeared round
- the palpebree of the left eye. The globe of the eye and all the
surrounding parts were protruded forward, giving to the
face a very frightful aspect. These lecal symptoms increased.
The eye was directed inward. Vision indistinct; finally lost.
Incisions were made into upper and lower eyelid, by Mr.
Adams, but no purulent matter was discharged. Finally, both
eyes were protruded, with total loss of vision. Erysipelatous
inflammation surrounded the palpebree of the right also, but the
disease had the priority in the left, by three days. On the
morning of the fourteenth day from her admission, and the third
from the appearance of the inflammation of the parts surround-
“ing the eye, she expired, without any symptom indicative of
inflammatory action having extended beyond the palpebre, and
the parts contained within the orbits. Small portions of wine ;
citrate of ammonia ; blue pill and carbonate of ammonia ; a blis-
ter to nape of neck ; occasional draughts of pulv. rhei ; infusion
242 Dr. Morgan’s Pathological Researches.
of senna, and camphor mixture; and saline draughts ; constituted
the chief treatment from the period of collapse—the applica-
tion of the blister being subsequent to the appearance of the
inflammation.
Autopsia, thirty-four Hours after Death.—Present Mr.
M‘Dowel, one of the Surgeons of the Richmond Hospital ;
Mr. Adams, the Surgeon, and Mr. A. Robinson, the resi-
dent pupil of the hospital. ‘The body was much emaciated.
The globe of the left eye advanced beyond its orbit, and
appeared between the palpebre, although they were much
swollen. An incision made between the roof of the orbit,
and the attachment of the left superior palpebra, gave exit
to pus mixed with a little blood. The dura-mater and other
membranes, on a superficial examination, appeared natural, as
did the brain itself, but when its basis was cut into, it was
found softened and infiltrated with serum, particularly in the
left anterior lobe where it lay over the orbit. At this part,
also, beneath the arachnoid, and between it and the pia mater,
there was a deposit of a greenish purulent lymph which seemed
to follow the track of the optic nerve into the brain. This
lymph was spread extensively over the inferior and lateral sur-
face of the whole of the left anterior lobe. Some watery effusion
was found in the ventricles; the presence of which might have
been expected where so much irritation had existed on the sur-
face of the brain. The thickening of the optic nerve, its en-
largement at its entrance from the brain into the orbit, and the
remarkable protrusion of the eye from its socket, all directed
our attention to that cavity, and called for a careful examina-
tion of the nature and state of its contents. That this latter
phenomenon was not caused by any free fluid which was within
reach of the scalpel, and could be evacuated by an incision, was
already proved by experiment on the same subject, both while
living and dead. The triangular bony roof of the orbit, de-
tached at each side from the rest of the frontal bone, was care-
fully raised; the whole of the periosteum covering the bony areh
Dr. Morgan’s Pathological Researches. 243
of the orbit, was found but loosely adherent, and a very careful
examination evinced, that, at one spot, true pus existed between
the roof of the orbit and its investing periosteum. The optic
and other nerves, the muscles, the cellular and adipose mem-
branes; in short, the whole contents of the cavity, the globe
itself excepted, exhibited the effects of a severe and rapid
attack of inflammation. 'The optic nerve was thickened, indurat-
ed, and covered with a tenacious layer of yellow lymph, while the
surrounding yellowish-green, adipose, cellular membrane seemed
to be in nearly a sloughy condition. It was the mixture of pus
m the interior of the orbit, and the tumefaction of all the struc-
tures surrounding the optic nerve, including the lacrymal
gland itself, an almost indistinct mass, which had caused that
most remarkable feature in this case, namely, the partial protru-
sion of the globe of the eye. The extension of the inflamma-
tion along the tractus opticus into the interior of the brain, the
effusion of serum into the ventricles, and especially the purulent
infiltration beneath the arachnoid of the basis of the brain, ac-
count for the fatal catastrophe, and the preceding symptoms; for
the other viscera were sound, if we except enlargement of the
liver, and strong adhesions of the pleuree connecting the right
lung to the sides of the thorax; neither of which could have
had influence in hastening the fatal event.
Here, then, is another well-marked instance of inflamma-
tion of the membranes of the brain, severe enough to deprive the
patient of life, yet without coma, delirium, pain in the head,
or im fact any obvious symptom by which the extension of the
inflammatory action from the parts within the orbit, to those
within the cranium, could be ascertained. Many reflections
here suggest themselves to the inquiring mind, but inaccordance
with the principles of my design, I give the facts, faithful and un-
adorned, leaving them to speak their own language, and con-
vey their own instruction.
244 Dr. Churehill’s Cases of Uterine Hemorrhage.
Arr. XVII.— Cases of Uterine Hemorrhage. By FLEETWOOD
Cuurcuitt, M. D., Licentiate of the King and Queen’s Col-
lege of Physicians in Ireland, Physician to the Wellesley
Lying-in-Dispensary, and Lecturer on Midwifery, &c. &c. in
the Medico-Chirurgical School, Digges-street, Dublin.
[Read before the Surgical Society of Ireland, Saturday, January 25, 1834.]
On a subject so importantas hemorrhage from the uterus, where
the most prompt and suitable treatment is required, and where
but.too often our best devised plans fail, no apology I trust can
be necessary for bringing before the society a detail of four
cases which have occurred to me in the practice of the Welles-
ley Dispensary. I do not assume to myself the credit of any
thing new in practice or profound in theory. It will be seen
that in the two first of the cases I merely state the results of
greater promptitude of action, and in the latter exhibit, if not
an unknown cause of flooding, yet one that is not noticed by
authors as producing its peculiar effects at that particular pe-
riod. And although in the cases to be recited, the reme-
dies employed were ineflicient,—the patient who recovered ap-
pearing to owe little to the means used,—still as throwing light
upon one variety of uterine hemorshage, I think they are of
considerable interest and importance. |
Case L—Mrs. Kennedy, et. 27, of fair complexion, red
hair, and delicate health, having had two or three miscar-
riages, was attacked with slight hemorrhage in the beginning
of May, 1832, which ceased spontaneously. She sent to the
dispensary at ten Pp. M. on Friday, May 25, 1832, on account
of a severe flooding, which came on after a fit of crying
without apparent cause. One of the senior pupils visited
her, and administered the usual remedies, but finding them in-
effectual, I was sent for. I found her blanched, faint, and com-
plaining of excessive exhaustion. Pulse very small, wiry, and
uncertain. ‘There were no labour pains, but slight stings in
Dr. Churchill’s Cases of Uterine Hemorrhage. 245
the belly were followed by the expulsion of clots from the
vagina ; in this way she had lost a considerable quantity of
blood. She stated herself to be within a month of her full
time.
On examination, the vagina was found very hot, tender, and
irritable, and the os uteri so high, that it was with great diffi-
culty I could reach it without being able to ascertain the pre-
sentation. No hemorrhage followed the examination. As the
flooding had greatly diminished, I directed her to be kept
quiet, to have cold applied constantly to the vulva, and to take
a large dose of laudanum.
At six o’clock on Saturday morning, she was visited by my
colleague and myself. Some more clots had been passed, but
not in great quantity. Pulse weak and quick. The os uteri
‘was quite beyond reach, unless by introducing the hand. This
the patient would not permit; it was indeed not without diffi-
culty we obtained an examination at all. As but little flooding
was gong on, we determined to wait awhile, that she might
rally. She was ordered infus. rosve c. acid. sulph. dilut. Con-
tinued cold to vulva. A plug of soft linen was introduced.
My friend, Dr. Darley, saw her, with my colleague, Dr.
Maunsell, and myself, about two p.m. She appeared better,
and refreshed by sleep, with scarcely any draining. Dr. Darley
was just able to reach the os uteri without ascertaining any
thing as to the presentation. After careful consideration of her
state, and the advantages of immediate operation, and of delay,
it was agreed upon to allow her to rest awhile, unless the he-
morrhage returned.
At ten p. M., she appeared rallying very quietly and steadily,
and it was determined, that if no hemorrhage recurred during
the night the operation of turning should be performed early
the following (Sunday) morning. At half past seven, Sunday
morning, I was summoned, as the flooding had returned. Dr.
Maunsell accompanied me, and we found her blanched, covered
with cold, clammy perspiration, and without pulse. She refused
246 Dr. Churchill’s Cases of Uterine Hemorrhage.
o, or to allow an examination. She became
to take any thing
very restless, throwing herself about in the bed, exclaiming,
<¢ that she did not know what was the matter with her ;” then
stretching herself out, she breathed shorter and at longer inter-
vals, and in a few minutes died. There was no draining dur-
ing our visit, and it was thought she might have lost a pint this
last attack. Permission to examine the uterus was obtained,
and the placenta was found implanted over the os uteri, from
which it had been detached to the extent of about half an inch
posteriorly.
On a review of this case, two reflections will probably occur
to the minds of most; first, that an accurate examination as to the
presentation ought, “ cowte qua coute,” to have been made ;
and, secondly, that the operation should have been attempted at
an early period. However evident and easy this may appear
now, many difficulties opposed themselves at the time. The
irritability of the vagina, the obstinate refusal of the patient to
permit more than the slightest examination, and the danger, by
disturbing the clots, of reproducing hemorrhage, which in her
exhausted state, might prove fatal ; all were arrayed against
our wish for a more perfect investigation. Her exhaustion, and
the disposition to rally quietly and steadily, with the little
draining, made us wish to defer the operation until it could be
performed with the greatest advantage to the patient.
Having said so much as to the motives which actuated us, !
may state fairly and candidly my own conviction, from the experi-
ence of the case recited, than an early operation would afford a
greater chance of recovery, even though a rally had not taken
place ; and my own determination, should I be called to other
cases of this kind, to deliver the patient as soon as possible. In
saying this I would not be understood as asserting that instant
delivery is either advisable or possible in every case. There
may be some reasons, from the state of the patient, which may
postpone or prohibit the operation, or the patient, as in the
above case, may refuse to submit to it. But in the majority of
Dr. Churchill’s Cases of Uterine Hemorrhage. 247
eases, where the os uteri is dilatable, the danger, which. is
doubled by delay, is not increased by operating immediately
without waiting for reaction. The following case will illustrate
my meaning.
Case 11.—Mrs. Brennan, etat. 30, mother of two children
at full term, and after natural labour. Sent up to the Welles-
ley Dispensary, for assistance, at midnight, May 10, 1833. A
pupil visited her, and found her much exhausted from severe
flooding. She stated, that for the last week she had lost a
pint of blood daily, and considerably more previously to send-
ing to the dispensary. :
On examination, he found what he thought was a placental
presentation, and I was summoned. Before my arrival some
slight uterine contractions occurred, and I found the os
uteri dilated to the size of halfa crown, very high in the pel-
vis ; with a slight membranous pouch protruding. I ruptured
this, and a great quantity of liquor amnti escaped. The head of
the child presented. Labor pains metiie and the
fiooding ceased, and all seemed going on well. In about half
an hour, however, a change took place, the pains became irre-
gular and more feeble, a dribbling of blood was observed, and
she complained of faintness. The vagina was found full of
clots, and I could no longer reach the presenting part. The
pulse became extremely feeble, often scarcely perceptible, and
irregular. I exhibited some stimulants, and sent to request the
assistance of Dr. Darley, to whose kindness on this and other
occasions I stand deeply indebted. On his arrival, it was de-
termined, notwithstanding the unfavourable state of the patient,
to proceed instantly to deliver. At this time the pulse was im-
perceptible at the wrist, the heart’s action feeble and_flut-
_ tering, and the surface cold. I had no difficulty in introducing
my hand, which came in contact with the right side of the tho-
ax of the infant. The extraction was performed with little
pain, and followed by no hemorrhage. The placenta was ex-
pelled in half an hour, and the uterus contracted firmly. The
VOL. Vv. No. 14. 2«
248 Dr. Churchill’s Cases of Uterine Hemorrhage.
bag of the membranes was found entire, except a perforation at
the edge of the placenta through which the child passed. The
child of course was dead. At the termination, the pulse was
just faintly perceptible; the patient, however, said she felt
somewhat better. She was left under the care of an intelligent
pupil for the night. Fifteen drops of laudanum in cinnamon
water were ordered as a draught, to be given every half hour,
until some narcotic effect should be produced. Wine was ordered,
but she refused to take it. After a few doses of the laudanum
she became quieter, and towards morning obtained some light
sleep. Her skin became warmer, and no hemorrhage occurred.
On visiting her early next morning, I found her much better
than we had anticipated. She felt very weak. Her pulse were
quick and feeble, yet distinct. Skin warm. No after pains.
Lochia scanty. She had taken about 180 drops of laudanum,
and appeared a good deal under its influence. It was now dis-
continued, and from this moment, without aid from stimulants,
and with no untoward symptoms, she progressively recovered,
and is now perfectly well. ‘The catamenia have since appeared.
“The success attendant upon the operation in this case is the
best commentary on the advantage of prompt delivery, even un-
der the most discouraging circumstances. She was so much
exhausted, that it was not improbable that she might die under
the operation. Had any further flooding taken place, we should
probably have failed. Still as delivery afforded her the only
chance, we determined to incur the responsibility, and the suc-
cess was almost beyond our hopes. We were favoured, doubt-
less, by the mode in which the placenta was implanted. From
the situation of the perforation I made, it is evident, that the
os uteri was only partially covered by it; each successive dila-
tation leaving a larger space for the protrusion of the mem-
branes, and at length allowing room for the extraction of the
child, without any laceration of the placenta. ‘This is not the only
case in which I have found the good effects of laudanum after
hemorrhage, given so as to produce an impression on the sys-
Dr. Churchill’s Cases of Uterine Hemorrhage. 249
tem. Its mode of action is probably by reducing all the vital
functions to the level of the circulating system, so that the de-
mand shall not be greater than the supply.
The two following are cases of flooding after delivery, owing
to the presence of a morbid growth within the uterus.
Case If].—Mrs. Fagan, etat. 45, a strong healthy woman,
mother of two children; was delivered of the last, September
7th, 1833, after natural labour. The lochia ceased gradually
about ten days afterwards. At six o’clock, a. m., September 21,
1833, on attempting to void urine, a gush of blood took place,
filling the ‘pot de chambre ;’ this was repeated before ten o’clock,
the time of my first visit to her. I found her very pale and
weak ; no headach. Cool skin. Pulse 100; small but not
very weak. ‘The flooding had quite ceased, and I forbore mak-
ing an examination per vaginam, lest I should reproduce the
- hemorrhage. The fundus uteri extended above the pubis, and
was more bulky than is usual a fortnight after delivery. I direct-
ed cold to be applied to the vulva, and prescribed a grain of
opium to be repeated in two hours,
At my visit the next day, (September 22), I found the
draining had continued slightly, and her weakness somewhat
increased. Pulse slower and weaker ; she seemed fretful. A
plug was introduced into the vagina, and I ordered two grains
of the acetate of lead, with half a grain of opium, every hour.
_ September 25rd. More draining, accompanied by discharge
of some clots. Pulse weaker. No effect seemed to follow the
medicine. A dose of ergot of rye was now exhibited, but with-
out any effect.
24th. Has passed no more clots. Feels very weak. Pulse
120; feeble. Mist. Ferri. Co. was ordered.
25th. As no benefit had resulted from the medicines admi-
nistered, I suspected some further cause for the mischief, and I
made a careful examination per vaginam. I found a round,
smooth tumour, just protruding through the open os uteri. It
felt soft and spongy. I could pass my finger round it, but not
250 Dr. Churchill’s Cases of Uterine Hemorrhage.
sufficiently high to ascertain its insertion. Its size appeared
-about that of the larger end of a hen’s egg. On examining the
abdomen, I noticed the uterine tumour to be a good deal dimi-
‘nished in size.
Dr. Johnson, who visited her with my colleague and myself,
was averse from performing any operation in her exhausted
‘state, and recommended tonic medicines and a more generous
diet. ‘The plug was continued, but seemed to cause great va-
ginal irritation. From this time but little draining occurred.
My friend, Dr. Montgomery, saw her a few days afterwards,
and at his suggestion, an injection of infusion of camomile with
acetate of lead, was used twice. or thrice a day, which lessened
the irritation of the vagina, and the uterus gradually contract-
ing, enclosed the polypus, so that it could no longer be felt, and
the os uteri appeared perfectly natural. A thin mucous dis-
charge continued for some days. The debility persisted a
long time, but at length her strength returned, and she is now
perfectly well. :
I regret much that I did not make an examination, per va-
ginam, at an earlier period, although from the diminution in the
uterine tumour, observed the very day on which I discovered
the polypus, it is probable I might not have been able to reach
the morbid growth previously. The hemorrhage here appears
perfectly analagous to those described as resulting from uterine
polypi, except that owing to the peculiar condition of the uterus
after delivery, it was probably much more profuse; the effect
on the system, doubtless, was much less than it would have been
had it occurred sooner after her accouchment. From the most
careful investigation I could make, I do not think that any of
the means resorted to had much effect in diminishing the flood-
ing, which appeared to subside gradually and spontaneously. 5
Lhave, in other cases, found the patient considerably annoyed by
the irritation of the vagina, arising from the presence of a plug.
The interest excited by this case had scarcely subsided, when [
was called upon to visit a patient in whom I had an opportunity
Dr. Churchill’s Cases of Uterine Hemorrhage. 251
of contrasting the effect produced by a similar cause, acting
during the progress and immediately after delivery.
Case IV.—Mrs. Clarke, wt. 34, a strong healthy woman,
mother of three children, was taken in labour at seven o’clock,
p.M., January Ist, 1834. Presentation was natural, and the
progress satisfactory. ‘The head was expelled about 9 o’clock,
accompanied by a profuse hemorrhage, causing faintness. A
considerable interval elapsed before the expulsion of the body,
which was followed by gushes of blood. The pupil who at-
tended her applied cold to the lower part of the abdomen and
vulva, and fixed on a tight binder with compress. I visited her
at half past nme, p.m. The skin was blanched and cold ;
pulse rapid, and scarcely perceptible ; hemorrhage had ceased ;
placenta not expelled. Removing the binder, I applied pres-
sure by the hand to the uterus, and after a short time it con-
tracted, though not firmly. I now removed the placenta, which
was followed by some clots of blood : a series of compresses
were placed on the uterus, and the binder tightened: some
stimulants were given, and the patient appeared to rally: her
pulse became more distinct and firm, and she said that she felt
stronger: no draining. After remaining a considerable time,
and no bad symptoms recurring, I left her in charge of a pupil,
who staid some hours with her, and finding a gradual improve-
ment, returned home, leaving directions with her attendants.
About four, a. m., January 2nd, she became rather feverish,
and a great hemorrhage followed; cold was reapplied, the
binder tightened, the acid mixture given, and an ether draught.
The flooding subsided. I saw her at nine, a. m., the pulse
was just perceptible and very quick ; surface cool ; eyes sunken,
and an expression of great anxiety in her face; no draining.
I gave her a scruple of ergot of rye, in decoction, without appa-
rent effect. At twelve, a. m. I was again summoned; the
flooding had returned ; the uterus felt large and flabby; pulse
imperceptible at the wrist ; restlessness and anxiety. I gave
her half a drachm of ergot, which was rejected. by the stomach ;
252 Dr. Churchill’s Cases of Uterine Hemorrhage.
and in about half an hour, after a discharge of a great quantity
of coagula, she expired.
As may be supposed, the circumstances of this case caused
me great anxiety; the favorable condition of the woman before
delivery, the rapidity with which death followed, the signal
failure of all the usual means of arresting uterine hemorrhage,
notwithstanding their prompt application; all conspired to
make a post mortem examination a matter of great importance,
and I was fortunate enough to succeed in my request for one.
We found the uterus larger than natural, of a pale colour,
containing little blood in the sinuses, and the cavity apparently
filled with coagula; on removing these carefully, a morbid
growth was discovered about the size of a duck’s egg, attached
by its broad extremity to the fundus uteri; its tissue evidently
continuous with that of the uterus ; its texture, loose and fibrous,
was easily separable into distinct parts, without apparent
blood-vessels, and with no continuous membrane covering it.
A careful examination discovered no vessel from which the
blood had escaped ; the placenta appeared to have been attach-
ed partially, at least, over the polypus. The preparation is in
the museum of the Digges-street School of Medicine.
The resemblance of this case to the one recited is very strik-
ing, neither were preceded by any symptoms which could point
out the probable occurrence of flooding: in neither was there any
thing at the time which indicated an origin from organic dis-
ease, and in neither was any beneficial effect produced by the
usual remedies: unfortunately, in the latter case, the circum-
stances under which the hemorrhage occurred led to a fatal ter-
mination. In both the tumour, as far as we could ascertain, was
nearly alike in size, and communicated a similar feeling to the
finger ; and in both, I should suppose, it was of recent growth.
Why an apparently unorganized tumour should give rise to so
profuse an hemorrhage, except by preventing uterine contrac-
tion, I confess myself unable to explain; yet, had that alone
been the cause, how can we explain the delay of a fortnight after
Dr. Churchill’s Cases of Uterine Hemorrhage. 203
delivery in Mrs. Fagan’s case. It is an extensively ascertained
fact, that flooding is an accompaniment of polypus in the ordi-
nary states of the uterus, but hitherto I have seen no explanation
of its occurrence perfectly satisfactory.
The only remedy which a knowledge of this case would
suggest, as being at all applicable to similar ones, is the exhi-
bition of ergot, with constant manual pressure upon the uterus,
on the one hand, and a plug introduced into the vagina on the
other. I need scarcely mention, that the latter remedy, with-
out the former, would be merely to substitute internal for
external hemorrhage.
BIBLIOGRAPHIC NOTICES.
Notices concerning Works on the Practice of Physic, Sur-
gery, Pathology, and Physiology, recently published in
Germany.
(Continued from Vol. LV. page 424.)
Tur following is extracted from the number of Hecker’s Lite-
rary Annals of Medical Sciences, published in December,
1832, and contains so complete and structive a view of the
subject concerning which it treats, that I have been induced to
give, not an abstract, but a literal translation of the whole paper ;
at the present moment, indeed, when the subject of the func-
tions of the nervous system has excited renewed discussion, and
the opinions advanced by Sir Charles Bell have again been
submitted to the test of experiment, it is of great consequence
that the labours of continental physiologists should be made
known as speedily as possible to their English brethren. The
analysis published in the January number of the Medico-Chi-
rurgical Review of the experiments instituted by Professor
Miller, of Bonn, has consequently been gratefully received by
those interested in the progress of this important investigation,
a circumstance which has confirmed me in the belief, that the
labours of Dr. Stannius would excite a similar interest. From
a perusal of the following paper, it will appear, that Dr. Stan-
nius differs in some important particulars from Treviranus, and
those who maintain that the nerves or the ganglia control
and regulate the function of the circulation, a doctrine brought
forward by some in explanation of the pathology of Asiatic
cholera, and lately advocated in a well known medical society
in England.* |
* Liverpool Medical Society, vide Medico-Chirurgical Review, edited by
Doctor Johnson, January 1834, p. 187.
Modern German Works. D545
Ueber einige Functionen des Nervensystems. Von Dr. H.
Stannius, praktischen Arzte in Berlin.
On certain Functions of the Nervous System, &c. §c. Se.
SECTION I.
No great interval of time elapsed between the discovery, that:
sensation and motion depend on the nervous system, and the.
attempt to ascertain with accuracy by what portions of that sys-
tem these functions are respectively performed. Thus Rufus of
Kphesus* relates, that Eristratus distinguished between nerves of.
sense and nerves of motion, and that he believed the former to
be hollow, and formed by the membranes of the brain, while
the latter are derived from the substance of the cerebrum and
cerebellum.
_- Galen divided the nerves into hard, soft, and intermediate.
The hard are destined for the function of motion, and the soft
for sensation, while those of an intermediate consistence serve
partly for one, and partly for the other purpose. The hard
nerves he derived chiefly from the spinal marrow, the soft from
the anterior part of the cerebrum, and the intermediate from
the medulla oblongata. He believed that the posterior portion
of the medulla oblongata gives origin to most of the motor
nerves, and some few of sensation, while the proportion is re-
versed with regard to the nerves derived from its anterior half.
Succeeding physiologists either assumed the existence of cer-
tain hypothetical differences of structure in the nerves them-
selves, and thus accounted for the difference of their functions
in different parts of the body, or else they supposed that the
functions of the nerves are modified by the structure of the
organs to which they are distributed.
Treviranus} in his youth proposed the theory that sensation
i te on the medulla of the nerves and motion on their neu-
rilema. |
Charles Bell,§ in the year 1811, in a book circulated only
among his friends, came forward with the following announce-
ment :—
‘“‘ The difference observed between the ftnctions of different
* De Corp. Human. part. appellat. lib. ii. p. 65, ed. Clinch.
+ De Usu part. lib. ix. c. 14, p. 523, et alibi.
+ Physiolog. Fragmente. Vergl. Biologie. Bd. v. s. 346.
§ An Idea of a new Anatomy of the Brain, submitted for the observation of the
author’s friends. Compare also, Romberg’s Translation of Bell’s Physiological
and Pathological Researches concerning the Nervous System, Berlin, 1832.
VOL. Vv. No. 14, 2 Is
250 Bibliographic Notices.’
nerves, depends on the difference of their origin from the brain and
spinal marrow; every nerve with two functions possesses themy 1
virtue of its being formed by means of a double root, &c.”
In this essay he asserts that he had laid bare the roots of the
spinal nerves, and had cut the posterior row of roots, without
producing any convulsions in the muscles these nerves supply,
while, on the contrary, the moment he touched the anterior
roots with the point of his knife, these muscles were convulsed.
Bell’s views do not seem to have been adopted at the period
of their promulgation by any one except his son-in-law, Mr.
Shaw, * and hence we can explain how it came to pass that .
John Cross,t in 1815, advanced the hypothesis that the an-
terior pillars of the spinal marrow are destined for sensation,
and the posterior for motion. Alexander Walkert contested
the originality of this discovery, and asserted that he had taught
a similar doctrine beforé the publication of Mr. Cross’s paper.
In 1818, Burdach,§ assisted by V. Baer, made a series of
experiments on frogs, and arrived at the result, that the united
influence of both the posterior and the anterior roots.is neces-
sary to produce in any spinal nerve, a perfect discharge of
function, whether of motion or of sensation. At a later period,
Burdach, having again repeated these experiments, thus ex-
presses himself :||—
‘© T saw that irritation of the posterior roots caused convulsions,
and that their division produced relaxation and paralysis ; while divi-
sion of the anterior roots occasioned also paralysis, and that in @
ereater degree, while it also deprived the parts of sensation. After
division of the posterior roots ensued debility bordering on or resem-
bling paralysis; while after division of the anterior roots, ensued a
complete extinction of the vital powers of the limb.”
In 1822, Shaw communicated to Majendie the views en-
tertained by Charles Bell, and Majendie{i immediately com-
menced a series of experiments on the cerebral nerves, and on
the roots of the ‘spinal nerves. The latter seem at once to
have led to the most decisive results. ‘Thus in a young dog,
having divided the posterior root of the spinal nerves, he says >
‘The sensibility was always completely extinguished.”
* Manual of Anatomy, 1821.
+ Thomson, Annals of Philosophy, vol. v. (#815,) p. I12.
+ Ibidem, p. 317, and vol. vi. p. 120.
§ Vom Bau und Leben des Gehvins, Th. 1, S. 263.
|| Ibidem, Th. 3, S. 400.
4 Majendie, Journal de Physiologie, T. il. p. 276, et seqe
}
Modern German Works. O59
When the anterior roots were cut,
“‘The limb became relaxed and motionless, while it evidently re-
tained its sensibility.”
And finally he thus expresses himself at the conclusion of his
essay :
“« The posterior roots appear destined more particularly to fulfil the
functions of sensibility, while the anterior roots are more especially
connected with the function of motion.”
But in a second dissertation* upon the same subject, he says—
‘¢ These facts seem to establish the conclusion, that sensation does
not derive its origin exclusively from the posterior nerves, nor motion
from the anterior.”
Fodera+ was the next to publish on this subject, but his
results were still more inconclusive than those obtained by Ma-
jendie, and in some instances were quite opposed to them.
Bellingerit assures us he has found that extension of the
limbs depends on the posterior pillars and roots, while the
power of flexion is derived from the anterior.
Schéps§ did not arrive at any very well established or
satisfactory conclusions from his experiments on the mammalia.
Backer, || whose essay I have not been able to obtain, 1s
said to have been more fortunate in obtaining decisive results,
and Beclard{ speaks likewise of a similar success, but does
not enter into the details.
Such was the state of the question when Joh. Miiller **
ublished an account of his experiments on frogs, from which it
followed that Bell was perfectly correct in assigning the origin
of motion to the anterior, and of sensation to the posterior
roots.
Experiments performed in the presence of Scarpa by Pa-
nizza,t+ and by Seubert,tt in the presence of Tiedemann and
Arnold, are said to have led to results not less decisive. Less
a =
* Majendie, Journal de Physiologie, t. 1. p. 367, et seq.
+ Ibidem, t. ii. p. 191.
¢ Bulletin Médical, 1824, i. p. 299.
§ Meckel’s Archiv. 1827.
|| Comment. ad Question Physiol. Med. Acad. Rheno, Traject. 1828.
q Elém. d’ Anatomie Génér. p. 668.
** Froriep’s Notizen aus dem Gebiete der Naturund Heilkunde, No. 646 und
647. Marz 1831. Annales des Sciences Nat. 1831. Romberg’s German Transla-
tion of Charles Bell’s Views, 1832, 8.375. Meckel’s Archiv. 1832, Bd. 6, S. 67.
tt Scarpa de Gangliis Nervorum de que Origine et Essentia Nervi Intercos-
talis, ad H. Wererum Epistola. Mediolan. 1831.
tt Bischoff Nervi Accessor. Willis. Anatomia, p. 79,
258 Bibliographic Notices.
favourable to the new doctrines were the conclusions at which
Gottfried Reinhold Treviranus arrived.
‘© T observed, says he, in all the frogs on which I performed this
operation, that life was extinguished much sooner, than it usually is
in those experiments where all the viscera of the abdomen and chest
are excised, while the spinal marrow remains untouched. They
were attacked with opisthotonus the moment the air had obtained en-
trance into the spinal cavity, and, therefore, the motions observed to
follow irritation of the posterior roots may be considered as automatic,
and not as indicative of the animal’s feeling pain.
<¢ No nerve of motion which enjoys an uninterrupted and continu-
ous course from the brain or spinal marrow, to the external parts, is
entirely destitute of sensation, and again we may suppose, that the
nerves which are limited to sensation, are so limited only, because
the parts they supply are incapable of motion.”
Although my own experiments confirm the conclusions ar-
rived at by Miller, yet I am induced to publish them, partly
on account of the comparative novelty, and the paramount im-
portance of this physiological question, and partly because my
experiments have brought to light some collateral circumstances
of moment, tending to place in a strong light how careful we
ought to be in pronouncing judgment upon the facts or opmions
detailed by preceding authors.
My first step was to open with the greatest care the
spinal canal, either by means of a very fine scissors, one blade
of which was cautiously introduced into the canal, or by
means of a forceps; I next proceeded to remove the layer
which covers the spinal marrow, and which consists of a partly
membranous, partly flocculent, highly vascular tissue. This
done, I then attentively examined whether the functions of the
nervous system were thereby impaired or injured. In more
than an hundred experiments, 1 observed the opisthotonus
described by Treviranus only twice; in all the other instances
the animals leaped about as actively as if nothing had happen-
ed. Any hemorrhage which took place during the act of open-
ing the spinal cavity, I easily stopped by dropping on the part
a few drops of cold water, and after the operation was over, {
used to leave the animal for a short time in a bowl of cold
water. In this the animals moved about briskly, and exhibited
their usual degree of sensibility, when any portion of their sur-
face was irritated. When I divided the four or five posterior
roots of the nerve which supplies one of the legs, the animal con-
tinued to move that leg just as energetically as usual, but did not
exhibit the least symptom of uneasiness, either in the leg itself,
or any other part of the body, when irritating applications, how-
ever strong, were made to that extremity, and in one case this
Modern German Works. 259
insensibility lasted ‘or five weeks and a half after the operation,
in another three. Mechanical irritation of the extremities of
the divided roots, which were not in connexion with the limb,
never produced. the least motion in the latter. When the an-
terior roots of the nerve which supplies a leg were divided,
while the posterior were quite uninjured, the consequence was,
loss of both sensation and motion in the limb. The strongest
mechanical irritation of the foot, its amputation, or the cutting
off the leg itself, produced not the least disturbance on the part
of the animal, provided the matter was so managed, that the
hand of the operator was not seen by the animal during its ap-
proach to perform the operation. It is true, that frequently the
frog moved either spontaneously, or from being disturbed by
its body being shaken during the experiment, or from the
agency of some other accidental cause, but in the course of fifty
experiments, I only twice witnessed motions that could be set
-down to the account of stimuli directly applied to the limb.
The experiment was always conducted with the greatest cau-
tion, and especial pains were taken not to bruise, stretch, tear,
or otherwise injure in the slightest degree the posterior roots,
and yet I always obtained the same result !
Doctor Gadeckens, and Doctor Henle, witnessed my ex-
periments, and expressed themselves satisfied with the correct-
ness and accuracy with which they were performed, and their
testimony was the more valuable, because one of these gentle-
men, Dr. Henle, had been constantly present at Miiller’s expe-
riments. In truth, I was almost forced to conclude, that Mul-
ler had committed some oversight, and I was nearly convinced,
that the posterior roots were capable of transmitting sensation
from the limb, only so long as they remain in living contact
with the anterior, which preside over motion.
I now resolved to keep one of the frogs for some time after
the operation, and with that view I preserved the animal in a
glass of water. On the third day I took him out, and ob-
served, that when I pinched or otherwise irritated the foot of
the leg, the anterior roots of whose nerve had been divided, that
the animal exhibited indubitable proofs of feeling the irritation ;
the next day the motions in the rest of its body which followed
the irritation of the same foot, were still stronger, and on the
- sixth day, matters had so far altered from what I had observed
immediately after. the division of the anterior roots, that the
sensibility of the foot and leg seemed, if any thing, greater than
natural, for the animal could not bear these parts to be touched
im the gentlest manner, without evincing symptoms of the great-
est uneasiness. I preserved this frog alive for five weeks longer,
and at the end of that time I could not perceive the slightest
260 Bibliographic Notices.
indication of the limb having regained its power of motion.
Similar or nearly similar results were uniformly obtained, and I
could not help feeling strongly, that my conclusions still differed
very materially from Mitller’s, for he had observed, that sensa-
tion was not impaired immediately after the operation of dividing
the anterior roots. At last, however, a combination of circum-
stances led me to form the opinion, that the sensibility of the
limb, in my experiments, had been impaired by the cold water
[ used to stop the hemorrhage. Accordingly, I again repeated
the experiment, using a sponge very slightly moistened to re-
move the blood, and avoiding pouring cold water on the spinal
marrow, or placing the animal in cold water. When I had
adopted these precautions, I obtained in eleven successive ex-
periments the same results precisely as Miiller ; thus after divi-
sion of the anterior* roots, the extremity altogether lost its
power of motion, but when any part of that limb, as for instance
its skin or toes, were mechanically irritated, the animal dis-.
played indubitable symptoms of the irritation being felt, for it
instantly became uneasy, and moved the head and three other
extremities in the manner it is accustomed to do when in pain.
When I placed a frog thus operated on in water, it still dis-
played evidence of feeling any irritation applied to the limb
rendered destitute of motion. The apparent discrepancy be-
tween Miiller’s experiments and mine cannot, therefore, be at-
tributed to any power which water in itself possesses of acting
specifically in such a way as to diminish sensibility; the diffe-
rence in our results may be more satisfactorily explained by the
peculiar effects produced by cold water, when it is dropped or
poured upon the exposed spinal marrow, for in my experiments
the shock thereby imparted, had for the time deprived the pos-
terior roots of their power of feeling : mechanical irritation, ap-
plied to the posterior roots of the nerves cut off from the spinal
marrow, had never the least .effect upon the frog.
On the whole the following results may be derived from my
experiments. 1st. The posterior roots have no power of con-
veying impressions from the centre to the periphery, they are
not capable of exciting motion, nor do they possess the power
of gradually assuming that function when the proper nerves
of motion have been divided. Their proper and peculiar
office is to convey the sensation of impressions made at the pe-
riphery to the centre of the nervous system. 2nd. The ante-
rior roots, on the other hand, enjoy the privilege of being the
conductors of volition, and convey impressions from the centre
ScUnIETnTInESEIEEETE Eo nnn nnn n eee UU tEttEEEE EES EC
* In the text itis posterior, evidently a typographical error.—Translator.
Modern German Works. 96h
to the circumference; in a word, they preside over muscular
motion.
In the detail of Fodera’s experiments, many circumstances
are related which seem to indicate, that the reverse holds good
in the anterior extremities, but these circumstances have been
explained by Miller, who has clearly proved, that the several
roots of the spinal nerves perform the same functions in these as
in the posterior extremities. It is true, that when the posterior
roots are divided, the frog moves its arms in an awkward man-
ner, and seems to possess less power of grasping bodies, nor in
the sequel does this power appear to be recovered. — Still, how-
ever, a considerable power of motion remains. It is worthy of
remark, that in two out of twenty frogs, in whom I had divided
the posterior roots of the nerves which supply the arms,* a tem-
porary loss of motion accompanied that of sensation, although
no injury had been apparently inflicted on the anterior roots.
In both cases, however, the power of motion was restored in
about half an hour. When the anterior roots of the nerves sup-
plying the leg of a frog have been divided, and that lee is then
irritated mechanically, a twofold reaction is observed in the
animal, viz.,an attempt to move or jump with the other leg, and
with both arms, and a sudden motion of the whole body, in-
cluding the head; this latter motion appears convulsive, as if
the animal suddenly shuddered from fright. I have not been
able to perceive, that either of these motions occurs antece-
~ dently to the other. Still, as one is evidently a combined
movement, destined as it were to perform some given object, a
character which the other wants ; there is little doubt, that they
depend upon the agency of different portions of the central or-
gans of the nervous system.
This supposition is strengthened by the following experi-
ments. Ist. Having carefully opened the head and _ spinal
canal of a frog, and divided the anterior roots of the nerves
supplying one of the legs, I next cut the spinal marrow across,
where it arises from what is in the frog termed the cerebellum.
I then removed both cerebrum and cerebellum. When me-
chanical stimuli were now applied to the leg thus deprived of
its motive powers, the other leg was merely drawn towards the
body suddenly, with more or less strength ; when the irritation
-was increased, both arms were likewise moved as if in the act
of preparing to leap. In this experiment the shuddering, con-
vulsive motion was altogether wanting. 2nd. When after the
division of the anterior roots of the nerve supplying one leg, I
“ For brevity sake, I translate in the case of frogs, the anterior extremities
arms, the posterior extremities legs,
262 Bibliographic Notices.
cut the spinal marrow across, just above the origin of the nerves
of the posterior extremities; then the experiment never failed to
produce a drawing up of the other leg towards the body, as if
it was performing the motion necessary for leaping, and this
took place, not merely when the leg was uninjured, but when
the posterior roots of its nerve had been divided. From this it
follows, that when an irritation, acting upon the nervous extre-
mities, gives rise to motions in other and distant parts, this is
done independently of the agency of the brain and will. The
sudden shuddering of the whole body, which never took place
where the brain had been removed, may with great probability
be ascribed to a painful sensation. ‘These experiments like-
wise prove clearly, that when a leg, deprived of its proper power
of motion, is made to move by the application of a stimulus, it
does so in consequence of the pain thus felt, and not from other
causes.*
SECTION II.
Most physiologists are of opinion, that sensebility exerts an
‘mmediate influence on the circulation, even independently of
its influence on the heart. Many indeed go so far as to as-
sume, that the local circulation of any part must cease, when
that part is deprived of the active influence of its nervous
branches. Burdach seems to have adopted this view, and
Treviranus defends it in the following terms.
‘Ist. Division of the maih nerve which supplies any limb, 1s
immediately followed by the loss of sensation and motion. ‘The cir-
culation in the limb continues for a certain time, when it ceases, and.
the limb dies, unless indeed, as sometimes happens, it is saved by
the reunion of the extremities of the divided nerve. Thus it happens
to the leg when the ischiatic nerve is divided, and similar effects are
observable in the circulation of any part where the spinal marrow is
cut across above the origin of the nerves supplying that part; the
latter operation, however, produces in addition considerable effects on
the general circulation. These facts, continues Treviranus in ano-
ther part of his celebrated Biologie, prove, that each portion of the
spinal marrow presides over the circulation of the organ it supplies
with nerves. This it does too, quite independently of any agency it
may exert on the heart, for the general circulation continues undis-
turbed after all motion of the blood has ceased in the limb, whose
connexion with the nervous system had been cut off. The circula-
tion does not instantly stop in a limb when its nerves are divided, for
this reason, that every nerve retains enough of energy to maintain
issn tet Eg te kN ner aay eR eee A
* The author remarks, that when the medulla spinalis or oblongata is cut
across, the froz immediately appears lifeless, but after some time recovers.
Modern German Works. 263
thecireulation fer a certain time after its own communication with
the cerebro-spinal system has been interrupted. As it is now insu-
lated, and obtains no fresh supplies of nervous energy, its power of
maintaining the circulation necessarily soon ceases.”
Towards the end of the second volume of his Biologie,
Treviranus details the experiments on which he founded this
doctrine. They are as follows:—When both the ischiatic
nerves of a frog were divided, the circulation of the blood in
the webs of the feet ceased in the space of two minutes. In
another frog this operation was followed by a great dimmution
in the energy and quickness of the circulation in the foot; but
it contmued in this enfeebled state for some time. When the
spinal marrow was cut across in the middle, the motion of the
blood in the feet continued a full quarter of an hour after
the operation, without becoming notably slower. In another
frog the circulation of the blood ceased at once in the legs
when the ischiatic nerves were divided. Jn a full grown and
very lively female frog, the circulation in the feet lasted ten
minutes after the spimal marrow was divided in its middle part.
When examined after the lapse of eight hours, all motion of the
blood had ceased in the larger vessels, but still continued in
the capillaries. In another frog the circulation in the leg con-
tinued more than half an hour after the division of the ischiatic
nerve. Such are the facts upon which Treviranus founded his
opinion, and fully relying on which, I was induced to make
some experiments with the view of determining whether the an-
terior or the posterior roots of the nerves exert the greatest in-
fluence on the circulation. But I could not detect the least al-
teration in the circulation of the animal’s leg, either when I di-
vided all the anterior roots, or all the posterior, or both. The
circulation did not appear to be disturbed, either immediately
after the operation, or during the course of five weeks. It is
to be observed, that I kept the frogs so experimented on, in a
glass containing water enough to cover every part of the body,
but the head and back. Frogs also which were kept, but not
in water, for several days after the operation, exhibited no de-
rangement of the circulation of the blood, either in the anterior
or posterior extremities. Having cut the spmal marrow across,
just above the origin of the nerves of the legs, and having
moreover cut away a little bit from the end of the anterior por-
tion, in order to prevent all possible communication between it
and that connected with the legs, I observed in about ten cases
a sudden cessation of the circulation, immediately after the ope-
ration, in the webs of the feet. In such cases the frog was in-
variably ina state of apparent lifelessness, being deprived of
VOL. Vv. NO. 14. 2M
264 Bibliographic Notices.
sensation and motion, not merely in the extremities below, but
in those above the incision. Sensation and motion were restored
in the anterior extremities, sometimes so speedily as in three
minutes, occasionally not before twelve. Somewhat later the
legs also were acted on by stimuli applied to their surface.
The circulation in'the vessels of the web ceased in general for
only a few minutes, and never for more than twenty, after which
it recommenced but in a more sluggish manner than before the
operation. When I applied salt to one of the feet, I observed
an immediate efflux of blood to the part, and the web exhibited
speedily an injection of all its capillaries with red blood. In ten
cases the operation above described produced no obstruction
whatever in the circulation of the feet. One frog, whose spinal
marrow had been thus cut across, and a bit excised, I preserved
alive for eight days, without being placed in water, and_ the
animal no. doubt would have survived much longer, had I not
submitted it to another experiment. In this frog, any mechan-
ical irritation of either foot produced immediate retraction, not
merely of the corresponding, but of the other leg. The blood
too circulated rapidly and evidently in the vessels of the web,
and on the eighth day blood flowed in abundance from a wound.
inflicted on one of the thighs.
Two other frogs in whom the spinal marrow was cut across,
and a bit excised, were placed in a vessel of water. One of.
them ceased in six hours and a half, and the other in eight
hours, to betray any symptom of re-action on the application of
stimuli to the toes, or the skin of the legs.. In both, the circu-
lation of the blood in the vessels of the webs of the feet conti-
nued for six days, when they were killed. In two full grown
female frogs, I divided all the nerves which the posterior extre-
mities derive from the spinal marrow, and to prevent all further
communication, I excised the portion of the spinal marrow
which gave them origin. No re-action of the legs took place
on the application of stimuli to their surface. ‘The circulation.
of the blood in the webs of the feet went on without interrup-
tion. I placed both the animals in a vessel of water, and ob-
served them for five weeks. Sensation and motion did not re-
turn, but the circulation of the blood remained unimpaired.
The posterior extremities did not undergo any evident diminu-
tion in size, but secreted from their surface (in much greater quan-
tity than the anterior) a thick, clammy mucus, which I frequently
found in large quantity on the skin of these parts. Jn all the expe-
riments I had hitherto made, I had divided the roots of the spi-
nal nerves before the formation of the spinal ganglion, and, con-
sequently, before they had formed any communication with the
sympathetic. I next opened the abdominal cavity in two frogs,
Modern German Works. 265
and divided within it, all the nerves supplying both anterior ex-
tremities in one, and in the other those only which supplied one
leg. J then carefully settled the displaced viscera, and stitched
up the abdominal parietes. No great vessels were wounded
during the operation. The blood continued to circulate in the
webs of the feet, although somewhat laneuidly, immediately
after the operation. ‘They were both placed in water, and ob-
served on the following day, when the circulation was found to
continue in the same state. The frog, both of whose legs were
paralysed, died on the day but one after, while the other sur-
vived eight days, during which no cessation of the circulation
in the affected limb could be detected.
I nave frequently succeeded in dividing the ischiatic nerve,
without injuring any considerable blood vessel ; in some of these
experiments this division was followed by a temporary arrest in
the circulation of the corresponding foot and its webs, but this
continued only for a few minutes; after which the circulation
was restored. In general, this operation did not produce any
stoppage of the circulation in the limb. Treviranus would un-
doubtedly have arrived at similar results, had he kept the ani-
mals on which he experimented, a longer time after the opera-
tion, fur the purpose of observing its effects. Yet he too found
on one occasion the blood cireulating in the smallest vessels of
the foot, eight hours after the operation.
It follows frem the experiments I have detailed, that nei-
ther the spinal marrow, nor any of its nerves, before or after
their connexion with the sympathetic, have such an influence
on the circulation of a limb, as to occasion it to cease, when all
communication between that limb and the rest of the nervous
system has been.cut off. When the circulation becomes weaker
in a limb, whose nerves have been divided, this occurrence
is to be ascribed partly te the loss of bleod during the opera-
tion, and partly te the constant state of rest in which the pa-
ralysed limb necessarily remains, in consequence of which, it
naturally attracts less blood to itself. The more energetic
and repeated are the exertions of any organ, the greater the
quantity of blood it requires and obtains from the general mass
of circulating fluid ; hence less blood flowing to paralysed parts
they become emaciated, and in some cases a perceptible dimi-
- nution in the calibre of their main artery takes place. But
what caused the sudden stoppage of the circulation which Tre-
viranus observed so often, and J oceasicenally ? It cannot be too
often repeated, that the animal system is an undivided whole ;
every component part may re-act not merely on the organs with
which it is more immediately connected, but on the whole
frame, and when any part is of great consequence in the sys-
266 Bibliographic Notices.
tem, its sfructure cannot be injured, and its functions destroyed,
without a great derangement in the whole system being a neces-
sary result. If the injury be inflicted suddenly, this result is
cbiained with more certainty, and to a greater degree. In this
manner { think we can account for several facts observed in ex-
periments similar to those above detailed, and it is to the shock
received by the system at large, in consequence of the sudden
cutting of the spinal marrow, that we are to attribute that com-
plete and general loss of sensation and motion, which takes
place and lasts for a few minutes after this operation, and to this
general shock also must we attribute the cessation of the circu-
lation already spoken of. In conformity with this view of the
question, we can explain why the circulation stops more fre-
quently, and for a longer time, after division of the spinal mar-
row, than after that of the ischiatic nerves.
SECTION III.
I opened the spinal cavity in several frogs, cut the marrow
across just above the origin of the nerves which supply the legs,
and then removed the brain together with the whole of the spi-
nal marrow, above (anterior to) the point of division. ‘The an-
terior extremities, whose central nervous system was thus de-
stroyed, were totally deprived of sensation and of motion, on
the application of stimuli to the periphery of the nervous sys-
tem. When the anterior roots of the divided nerves were
pricked, the limb which they supplied was convulsed, when one
of the toes of the posterior extremities was irritated, a sudden
contraction of the whole leg was the consequence. ‘These _mo-
tions sometimes took place at the same moment in both legs,
and then much resembled those which are made preparatory to
leaping. Irritation of the skin around the anus was the most
powerful means of exciting these motions of both the legs.
One of these frogs which was left in a china cup without water,
re-acted* during forty-eight hours after the operation, whenever
its toes and the skin of its legs were irritated. In other indi-
viduals the power of re-action continued for fifty-three, sixty-
two, seventy-three, and seventy-five hours, respectively ; when
irritation of the toes had ceased to procure any symptom of re-
action; it was often obtained by tearing the skin of the thigh.
And when the nerves belonging to this part also had lost their
conducting power, motions were occasionally obtained by ap-
plying the irritation to the parts im the neighbourhood of the
ee a
* By re-acted, is obviously meant, shewed symptoms of irritation, such as con-
. ?
vulsive movements, &e.
Modern German Works. 267
_anus. After all power of conducting impressions made on the
nervous ‘extremities to the spinal marrow had ceased, I opened
the thoracic cavity i the animals referred to, and generally
found the heart still beating; when this was the case its contrac-
tions continued in some instances as long as two hours after
opening the chest. In the individual where the power of re-
action continued seventy-three hours, the heart was found
empty, and yet it contracted when irritated with the point of the
forceps.
In general it may be remarked, that every mechanical irritation
of the anterior roots of the nerves produced contractions of the
muscles which the nerves corresponding to these roots supplied,
for several hours after the power of sensation had altogether
ceased in these parts. The pulsating organ which J. Miller
discovered,* and which is situated by the side of the anus, con-
tinued its contractions, seven, eight, and in one case so leng as
nine hours after the heart had ceased to beat. ‘The organ on
one side was often observed to continue pulsating, after that on
the other side had become altogether motionless. Its longest
diameter did not invariably correspond in direction with that of
the animal, for I saw it in several frogs longest transversely,
and in these cases the contractions of the organ proceeded from
without, inwards. All the phenomena hitherto described oc-
curred when I placed the animal, deprived of its brain and one
haif the spmal marrow, in a vessel without water, and in which
it was exposed to the direct contact of the air. But when a
frog so operated on was placed in a vessel with cold water, the
nerves of the posterior extremities lost their power of producing
motions when their periphery was irritated, in the course of
from five to eight hours. The resulting phenomena were the
same, no matter whether the animal was totally immersed in
water, or was merely placed in it, but in such a manner that it
did not reach to its back and spinal marrow. Mechanical irri-
tation of the motor nervous roots continued to produce contrac-
tions, after all conducting power from the periphery to the cen-
tre had ceased, but in avery short time even this symptom of
nervous influence disappeared. This peculiar effect of cold
water shewed itself also in those cases where I merely cut the
spinal marrow across, and then placed ‘the frog in cold water.
Sensation and motion continued undisturbed in the anterior ex-
tremities. The posterior re-acted, on the application of stimuli
to their surface, for six or even nine hours, after which, m three
instances, every trace of sensibility to cutaneous irritants had dis-
pA en Nh nt nt
* Poggendorf’s Annalen fur Physik und Chemie, 1832, 8.517,
268 . Bibliographic Notices.
appeared. The circulation of the blood, nevertheless, continued in
the webs of the feet. Two of these frogs, which I kept for six days
in water, did not in that time recover the power of re-action on
the application of stimulants to the posterior extremities. Ano-
ther frog was taken out of the water at the end of the third
day, and having been carefully dried, was placed upon a saucer.
The capability of receiving impressions from the application of
stimulants to the legs, had. not returned after the lapse of
twenty-four hours ; even the actual cautery, applied to the toes,
produced no appearance of convulsions. I regret that I ne-
glected to note the state of the circulation in the vessels of the
feet in this animal. Whence arises the deleterious influence
which cold water exercises on the nervous functions? is it to be
attributed to the cold? This supposition is invalidated by the
fact, that the same effects followed the application of water
which had been kept in the room for several days, and which,
consequently, had attained the same temperature as the aur.
Alexander von Humboldt long since remarked, that an organ
which lay in cold water for four hours, had become much less
irritable than a similar organ exposed to the air, provided that
neither the water nor air were above eighteen or twenty degrees
of temperature, (Reawmur). He is inclined to attribute the
debilitating effects produced by the water to its washing the
blood out of the part. |
I feel more disposed to adopt the opinion of Nasse, who at-
tributes the effects produced by water on parts still covered
with epidermis to its preventing the free access of air to the sur-
face. In corroboration of this, I may remark, that when I
placed a frog, deprived of the brain and the anterior half of the
spinal marrow, in oil, the animal lost every trace of feeling in
the course of half an hour, although before immersion, irritation
of the toes produced violent re-action in both legs. The sensi-
bility continued somewhat longer, when I strewed powdered
glass, charcoal, or sulphur over the legs of frogs deprived of
the brain and half the spinal marrow. But when these sub-
stances* were merely sprinkled on the legs, so as to allow some
access of air, the limbs retained. their sensibility longer. When
these parts were covered with common salt, the legs were im-
mediately thrown into the most violent convulsions, and per-
* I purposely made use of some substances belonging to the class of conduc-
tors, as well as others which belong to that of non-conductors of electricity—
no difference of result was however obtained. One frog, which lay on a thin
iron plate, and whose spinal marrow was connected with a thin piece of iron, re-
tained its irritability for sixteen hours, which is about the length of time it would
bave retained its sensibility if placed on glass or porcelain.
Cyclopedia of Practical Medicine. 269
formed the motions used in leaping, while the muscles became
stiff and hard, and the webs of the feet exhibited a most mi-
nute injection of their vessels with red blood. The sensibility,
however, was soon exhausted. I must here observe, that com-
mon salt produced these marked and violent effects in only
three cases ; in some later experiments its effects were not near
so striking. Many experiments upon the effects of warm water,
led to the very same results as those instituted by our celebrated
Humboldt.
Rosert J. Graves.
Cyclopedia of Practical Medicine-—Part x1x. London, De-
cember, 1833.
Tue credit which is reflected on Britis, medical literature by
this important publication, is decidedly enhanced by the late
numbers which have appeared. On afuture occasion, when the
work shall have terminated, we trust to render it justice, more
adequate to its merits than we have been enabled hitherto, by
a full review of it. The part for December, contains several
articles of the greatest importance, executed in a manner which
is highly creditable to the work and to the authors. At present
we select one for notice, with the object of laying before our
readers a summary of some recent researches on the pathology
of cancerous formations, a subject treated by Dr. Carswell, un-
der the head of Scirrhus. |
Richerand’s observation, that cancer is not less difficult to
define than to cure, is just as true at the present day, as when it
was made, and in fact is rendered only still more obvious by
the advance of pathological anatomy, which has shewn its spe-
cific relations to be more extended. Apparently under this im-
pression, Dr. Carswell judiciously waives the definition, and
having also forsaken his leading term scirrhus, he supplies in
its stead certain descriptive characters which belong to cance-
rous products im general, all of which he groups under the
generic denomination of carcinoma. They are the following :
1. They are essentially composed of a solid or fluid substance,
- different from any of the solids or fluids which enter into the
healthy composition of the body. 2. They often present in
the early periods of their formation certain characters common
to all of them, however much they may differ from each other
in the subsequent periods. 3. They all terminate in the gra-
dual destruction or transformation of the tissues which they
affect. 4. They have alla tendency to affect: successively. or si-
270 Bibliographic Notices.
multaneously several organs in the same individual. 5. They
all possess, though in various degrees, the same reproductive
character. Such are the characteristics common to scirrhus,
cancer, fungus hematodes, and the several kinds of sarcoma,
and which justify these morbid formations being considered as
having a generic relation. |
Dr. Carswell has seized upon a most important pathological
element, for dividing these products into species. It is found,
that some amongst them have no organizable power within
themselves, and seem to derive their nutrition, form, and ar-
rangement, entirely from the tissues in which they are deve-
loped. Others, on the contrary, are organizable ; although at
Jirst, their form and arrangement may be in a great degree de-
termined by external circumstances, yet they possess indepen-
dent properties by which their subsequent development is el-
fected. This then permits them to be separated into two
species, to the first of which Dr. C. has given the name of
scirrhoma, and to the second that of cephaloma ; and under
either of these heads may be arranged all the varieties of these
formations. We subjoin here a view of them thus classed, with
the denomination given to them by authors.
Scrrruoma, (unorganized) Crpnatoma, (organizable).
Scirrhus, properly so called. | Common vascular, or organized Sar-
Pancreatic Sarcoma, (Aber- coma, ( Abernethy.)
nethy. ) Mammary Sarcoma, (Abernethy.)
Lardaceous Tissue, (French | Medullary Sarcoma, (Abernethy.))\ ,,,, .
Pathoiogists.) Cerebriform or Encephaloid mat- Which when
Colloid matter, (Laennec.) 2 ter, (Laennec.) they protrude
Gelatiniform Cancer, (Cru- | | Spongoid Inflammation, ( Burns.) through the ul-
veilhier.) Milk-like Tumour, (Monro.) cerated integu-
Soft Cancer, (various authors.) ments are ¢all-
Pulpy Testicle, ( Baillie.) J ed,
Fungus Hematodes, ( Hey.)
Fungoid Disease, (Sir Astley :
Cooper.)
These specific characters are very important in a physiolo-
gical point of view; but it is to be stated, that as yet we have
only a glimpse of their existence, and are not warranted in
drawing any decided inference from them, as the capacity of
organization is very variable, and is affected by conditions
which we cannot apprehend. Besides, the well known obser-
vation is quite founded in fact, that some of the varieties pass
into each other, of which the best established example is fur-
nished by the organized scirrhus, which is frequently known to
change successively into the state of medullary sarcoma, and
fungus hematodes. ‘The distinction into varieties is, notwith-
standing, by no means to be overlooked, constituted as it is by
Cyclopedia of Practical Medicine. ait
marked difference in physical characters, (which are unneces-
sary here to be described,) and what is still more essential, by
different degrees of rapidity in their development, and in their
reproduction.
In searching into the seat, origin, and the mode of forma-
tion of carcinoma, it is in the first place to be observed, that it
is found in three situations: Ist, in the molecular structure of
organs; 2ndly, on the free surface of membranes ; 3rdly, in the
blood. |
The minute examination of the earliest appearance of car-
cinoma in a glandular structure, such as the liver, affords a
most interesting insight into the manner in which this substance
is deposited. It may be observed in a single acinus. This
can be seen to change gradually in colour, while its form and
bulk remain unaltered. It becomes in fact transformed by the
molecular deposit of this peculiar substance, in lieu of its pro-
per tissue, and the frequent examination of it leads to the per-
suasion that this takes place by its separation from the blood,
in the same way in which the ordinary nutrition of the organ Is
accomplished.
The study of its production on serous membranes is also
very instructive. Here it is to be regarded as a modification
of secretion, but the difference between the latter function and
that of nutrition is only nominal. In our present state of know-
ledge, at least, we have no means of distinguishing them except
by their results, and the investigation of these teaches us, that
the essential part of both these processes consists in the separation
from the biood of elements already existing in that fluid, Se-
veral observations of modern pathologists tend to establish the
important fact, that, occasionally at least, the products of dis-
ease are no exceptions to this order of secretion, instances of
which will recur to the reader, in the cases where coagulable
lymph, pus, tubercular matter, urea, &c. have been found in
the blood. None of these are, however, of such interest as the
facts with respect to carcinoma.
We have now to mention the existence of carcinoma in the
blood, which appears to us to be the most important part of
Dr. Carswell’s article, and which we have only to regret he has
not devoted more space to illustrate. |
“« The following facts may be adduced as furnishing strong evidence
that the formation of the carcinomatous substance takes place in the
blood, whether it be found in this fluid alone, or in other parts of the
body at the same time. First, the presence of this substance in the
vessels which ramify in carcinomatous tumours, or in their immediate
vicinity ; secondly, in the vessels of a portion or of the whole of an
organ, to the former of which the carcinomatous substance is exclu-
VOL. V. No. 14. 2N
272 Bibliographic Notices.
sively confined, and can be traced from the trunks into the branches
and capillaries; thirdly, in vessels having no direct communication
with an organ affected with the same disease, as, for example, when.
it is confined to a small extent of the vena porta; and, lastly, in
blood which has been effused into the cellular tissue, and on the sur-
face of organs.
‘‘'The appearances which the carcinomatous matter presents in
the blood are very various: sometimes they are perfectly similar to
those which mark its presence in the substance or on the surface of
organs. When contained in large veins, such as the vena porte: and
its branches, the emulgent vein, &c. it may present the lardaceous,
mammary, medullary, or heematoid characters all in the same venous
trunks. These varieties of the disease may be found mixed together
in minute qualities, or isolated into masses so conspicuous, that we
can readily distinguish them from one another. Sometimes they lie
merely in contact with the internal parietes of the vein; at other
times they are united with these by means of a thin layer of colour-
less fibrine ; or minute blood-vessels pass from the one into the other,
and are often very numerous and remarkably conspicuous in the
cerebriform matter. The divisions of the vascular system, in which
the carcinomatous substance has been observed, are the venous and.
the capillary, a circumstance which may be ascribed to the contrac-
tile power of the arteries preventing, under ordinary circumstances,
the blood from accumulating, and consequently this substance from
forming within them, and not to any peculiarity of function exer-
cised by the former. The presence of the carcinomatous matter in the
veins might be, and indeed zs in general supposed to be owing to its
having been absorbed by these vessels; but without entering into mi-
nute anatomical details which disprove such to be the case, we shall
again repeat the fact, that there are cases of carcinoma in which
the venous blood alone is found to be the seat of the disease. There
is no accumulation of the carcinomatous matter either in the vicinity
of the veins in which the blood is thus affected, or in any other part
of the body; and in those cases in which this complication exists,
as well might we refer the presence of this matter in the veins to
the exercise of the function of venous absorption, as that of cellular,
fibrous, osseous, and cretaceous formations in the same vessels to a.
similar process, which we know not to be the case.
‘‘ From this view of the origin of carcinoma in the blood, its for-
mation in the ultimate structure, and in the free surface of organs,
after the manner of nutrition and secretion, follows as a natural con-
sequence. The material element of the disease is separated from
the blood, and deposited under a variety of circumstances which mo-
dify in a greater or less degree the form, bulk, colour, and consist-
ence which it afterwards presents, in the several periods of its deve-
lopment. We cannot, therefore, limit the seat of the disease to any
one tissue, or ascribe its origin to any modification of structure or.
special organization, as has been done by several pathologists.”
ber ©
Cyclopedia of Practical Medicine. 213
We have quoted at length the words of the author in giving
duis account of carcinoma in the blood. The facts are of ex-
ceeding interest, and the arguments ingenious. We must con-
fess, however, that they would have appeared equally strong to
us, were not the conclusions stated in so positive a manner as
the last paragraph conveys, for although the evidence that car-
cinomatous matter is found in the blood is irrefragable, and we
think equally so that it is separated from it by the natural pro-
cess of nutrition or secretion, we cannot but think it premature
to say that it has its origin there, and to draw deductions from
this as an established fact. We are by no means unfavourable
to it, asa speculation, but we think the time is not yet come
for putting it forth as a doctrine. The following summary ob-
servations, contained in a latter section of the article on the
causes and nature of carcinoma, are unobjectionable, and seem
to us to be more in the cautious spirit of this able pathologist.
‘We must therefore conclude, that if carcimona make its ap-
pearance in individuals, however they may have been placed in re-
gard to the operation of what are called predisposing and exciting
causes, there must be present, in such individuals, a peculiar condition
or disposition of body, previous to the manifestation of the disease.
In what this disposition consists, we are entirely ignorant. Its very
existence is made known to us only by means of the peculiar cha-
racters of the products to which it gives rise. We have certainly
seen that the great function of nutrition is that which is more espe-
cially affected, and that, as the material element of carcinoma is con-
tained in the blood, it is highly probable that a modification of this
fluid constitutes the primary if not the essential condition of the dis-
ease. But, unacquainted as we are with the nature of nutrition as
a physiological function, we can offer no explanation of the nature
of the change effected in the blood, nor, consequently, of the nature
of carcinoma.”
In treating of the form, bulk, colour and consistence which
carcinoma presents in the different tissues and organs of the
body, and in the several periods of its development, Dr. Cars-
well, has given a minute and very interesting exposition of the
conditions which modify these physical characters. These,
however, we must leave unnoticed, as our object here is to ad-
vert to subjects more immediately connected with its patho-
logy.
Those of our readers who have given attention to this sub-
ject are aware, that the anatomo-pathologists of the present day
have not hesitated to assert that scirrhus and cancer are to be
considered merely as hypertrophy and induration of the cellular
tissue, and that this opinion has been especially advocated by
274 Bibliographic Notices.
Andral.* With the scalpel in hand, it is frequently the case,
thet no other anatomical element can be detected at the com-
mencement of these formations than a firm, pale, compact, cel-
lulo-fibrous-looking tissue, and to this the name of Aypertro-
phiated cellular tissue has been assigned. Ever since we have
considered this subject closely, we have regarded this doctrine
as unwarranted by analogy, and as an abuse of pathological
anatomy. We are now glad to find that the same view is taken
of it by so eminent an anatomist as Dr. Carswell, who shews
that real hypertrophy of the cellular tissue, such as it is found
in elephantiasis, and other affections, have no tendency to ter-
minate in carcinoma.
‘ Besides, admitting that a certain degree of hypertrophy may
precede the presence of carcinoma, the facts already brought for-
ward in illustration of the mode of formation of the disease, its seat,
and origin, clearly shew, that no such change is necessary, inasmuch
as all the varieties of carcinoma may form in situations in which the
cellular tissue is either extremely small in quantity or does not at
all exist. What, therefore, appears to be hypertrophiated cellular
tissue must be regarded a tissue sue generrs, produced by the uniform
distribution and molecular deposition of the carcinomatous matter,
either in the cellular tissue of an organ, or in an accidental tissue of
a similar kind, formed at the same time, and deposited along with
the carcinomatous matter. Such is, in fact, the manner in which the
cellular and fibrous tissues which enter into the composition of the
carcinomatous matter are generally formed.”
There exists much variety as to the quantity of blood-
vessels in the different species of carcinoma, they are rarely
perceptible in any of the varieties of scirrhoma, and seem to
consist, in this species, of branches from the tissue in which it
occurs, which have been enclosed in the deposit. It is in the
cerebriform matter that they are most numerous, constituting
often the greater portion of the tumour. In this variety they
appear to arise in the substance itself, apart from the tissues in
which it is developed. These most minute divisions terminate
by penicillated extremities in the carcinomatous matter, where
they communicate with veins and arteries belonging to the af-
fected organ. The latter vessels may be said to form the col-
lateral circulation of cephalorma, and are seldom so numerous
as the proper vessels. There are cases, however, in which it
forms the greater part of its vascular structure, and they are of
the greatest importance, as the nutrition is supplied by them,
and the destruction of the tumour is frequently caused by an
* Ginique Medicale, tom. iy. p. 404, Anatomie Pathologique, tom, is
p. 58. . .
Medical Periodicals in Germany. O45
obstruction in this part of its circulation. Mortification, either
partial or total, of carcinomatous tumours ts not an unusual oc-
currence from pressure of one mass on another, or from the con-
striction which the peduncle or base occasionally suffers when
the tumour has passed through an opening in a fascia, or in the
skin. Similar consequences occur, when it acts a local stimulus,
causing congestion. According to the degree of the latter it
produces at one time hemorrhage, at another softening, and at
a third sloughing. ;
We must here close our remarks, They are digested from
a consideration of a small proportion of Dr. Carswell’s article,
the remaining topics of which are treated with not less ability
than that to which we have adverted. ‘The whole shews the
industrious and learned pathologist, and contains a body of
profound and original research rarely indeed met with in
medical writings of any description at the present day, much
less in a cyclopedia. Criticism would be a bad trade, were
authors to be thus enrichers of medical science by their own in-
vestigations and discoveries. We should then have to doft
our judicial cap, and sit down and learn at their feet, or else be
content with asserting our dignity by grave recriminations of
our author’s style. There is no reason for fear, however, at
present, that we shall have to lament our “ occupation gone,”
from such an unnatural revulsion. |
We perceive that it has been impossible to embrace the
whole work, as was originally intended, in twenty numbers. We
congratulate the public, however, that the editors have not
been tempted to crimp any of the articles into a smaller space
than their authors thought fit, for the purpose of comprising it
in the number they had specified. This would have greatly
detracted from the work, and would have been an injurious
want of confidence in the subscribers. We are sure that in ex-
pressing our satisfaction that it is to be extended to twenty-
five numbers, inclusive of a supplement, we are only speaking
the feeling of the subscribers, and of all those who wish well to
this undertaking, so creditable to medical literature.
James Houeuton.
Medical Periodicals in Germany.
Tue following catalogue of German medical periodicals has
been made in compliance with the wish of several subscribers,
who are anxious to know the titles, prices, and characters of the
principal journals published in Germany. In Germany, as in
ae)
270 Bibliographic Notices.
Great Britain, the number of these publications has of late
years greatly increased, a circumstance resulting, in the opinion
‘of some, from the increasing vigour and growth of medical sci-
ence, but considered by others as a proof of the baneful pre-
dominance of superficial knowledge, combined with a restiess
love of novelty. Instead of attempting to explain the causes
which have produced the present state of medical literature, or
endeavouring to expose its disadvantages or its merits, let us
rather use every exertion to derive from that. system useful and
practical information, and let us strive to profit by things as they
are ordered, in preference to making useless efforts to effect a
change.
In the year 1829, the number of journals connected with
medicine and surgery; published in Germany, amounted to
thirty, and in 1832, to forty-one ; since which, several new
periodicals have been commenced, and at the present moment
probably not less than fifty are published in the German lan-
euage alone. It is a matter of some interest to compare the
‘number of periodicals with that of the other medical publica-
tions. Now, as we have already stated, the periodicals were in
1832 forty-one in number, and from the catalogues published
in the same year, it appears, that all the other publications ‘on
medicine, &c. including new editions, amounted to 370, so that
the proportion of journals to other medical publications 1s
as one to nine ; when we take into account, that several of these
periodicals are published weekly, and that few, with the excep-
tion of Tiedemann and Treviranus’ celebrated Physiological
Journal, appear at greater intervals than every two or three
months, while the greater number appear monthly, it is evident,
considering each number of a journal as a separate publica-
tion, that the periodicals actually out-number all the other me-
dical publications. This.is a curious fact, and at first.seems to
imply, that the German writers have abandoned their old pre-
dilection for deep learning, and, consequently, have preferred
amaking journals, rather than books published at their own risk,
the medium of their communication with the public. An at-
tentive examination. of the German periodicals will, however,
convince any one, that the contributors to these works are quite
as_-remarkable as-their countrymen have at any time been, for
the extent of learning and originality of research which their
writings display. In truth, for several years, some of the most
important accessions our science has received, have been com-
municated in the German Journals.
The following list contains the titles of those which seem
best adapted for the purposes of the British student.
Medical Periodicals in Germany. atk
1. Archiv fir Anatomie und Physiologie, von F. Meckcl.
Published every second month. Four parts make a volume.
Each part costs one dollar.* This Journal has been continued
in its present form since 1826, and was in fact a new series of
the Deutsche Archiv fiir Physiologie, which commenced in
1815. Iam not aware whether it is to be continued since the
late and lamented death of Meckel ; but it probably is, as its re-
putation is deservedly great, and its contributors numerous.
The volumes already published form a standard work, and are
_ indispensable to the physiologist, as they contain a great num-
ber of the original essays in which most important discoveries
in comparative anatomy and physiology were announced.
2. Zeitschrift Jur Physiologie ; in Vi erbindung mit mehreren
Gelehrien, herausgegeben, von Friedrich Tiedemann, Gott-
fried Reinhold Treviranus, und Ludolph Christian Trevi-
ranus.
This physiological Journal commenced in 1824, since which
only four volumes have been published, containing two parts
each. It does not appear at regular intervals. It is in quarto,
and what is rare for German books, the paper and printing are
excellent ; it abounds in plates well executed, and the essays it
contains are all executed by the ablest authors. Every number
contains several important communications, and in fact, the index
_ Of each volume is a register of discoveries. Thus in the last
number we have a masterly paper on the lymphatics of the um-
bilical cord and placenta, by Fohman, with an accurate repre-
sentation of the lymphatics of these parts minutely injected.+ It
is curious enough how slowly the discoveries announced in Mec-
kel’s or Tiedemann’s Journal find their way into our English
books. ‘The average rate of passage of a fact from Germany to
England is about two years, and many seem to have lost their
way altogether, for they have not yet arrived. In this respect,
with all due deference to our countrymen be it spoken, the
Americans have long been our superiors, and are much more
speedily and more extensively supplied with German intelli-
gence than ourselves. My late excellent and learned friend,
Dr. Duncan, did much to abate this evil, and it must be con-
fessed, that our literature is chiefly indebted to the journals of
Scotland, medical and philosophical, for a knowledge of the
progress of science in Germany. Lately, but only lately, our
ee Se ee ee ee ge
“The dollar here mentioned is equal to three and two pence British.
} For an extract from this paper see the Scientific Intelligence. «
278 Bibliographic Notices.
English brethren have followed the example, so that ere long
we may hope to see this department of our literature cultivated
as it deserves. ‘Tiedemann’s Journal is dear, the price of each
part being three dollars.
3. Journal der praktischen Heilkunde, hearusgegeben, von
C. W. Hufeland und EK. Osan.
The character of this Journal 1s too well known to require
any comment, It has long been more copiously quoted by
English writers, than any other German publication, a circum-
stance probably owing not merely to the intrinsic value of the
book, but also to the well merited reputation of Hufeland ; this
is a purely medical J ournal, and consists altogether of original
papers. It is published every month. Six parts make a vo-
lume ; the yearly subscription amounts to five dollars, and two’
thirds of a dollar.* The series commenced in 1795.
4. Wissenschafliche Annalen der gesaminten Heilkunde, he-
rausgegeben, von Dr. Julius Friedrich Carl Hecker.
This Journal has fifty contributors, all men of eminence, and
several of them foreigners. It consists not merely of original
communications but of reviews, and I particularly recommend
it to the English student. It embraces the various departments
of medicine, surgery, and physiology ; any one who can afford
to take but one German Journal, would consequently do well to
choose this. A part appears every month. The name before
1833, was Litterarische Annalen, and the annual subscription
amounts to eight dollars. This Journal commenced in 182.
The back numbers may be purchased at a small price, viz., the
first twenty-four volumes, from 1825 to 1832, for twenty-one
dollars, and one third of a dollar.
5. Archiv fir medizinische Erfahrung, von C. Horn, F.
Nasse und W. Wagner.
This Journal, also published in Berlin, enjoys an extensive
circulation ; it is published every second month, and costs one
dollar a number ; it commenced in 1801.
6. Heidelberger Klinische Annalen, von M. J. Chelius,
C. F. Harless, &c.
This appears, I believe, quarterly, and I am told by some
SO ee
* To prevent confusion, I have thought it better to make use of fractions of 2
dollar, than of the smaller coin called a groschen:
Medical Periodicals published in Germany. 279
German friends, is an extremely good publication. It costs
one dollar a number, and includes surgery as well as medicine ;
it began in 1825, and in the course of a few years, a coalition
was formed between its editors, and the conductor of a Journal
called Jahrbiicher der deutschen Medizin und Chirurgie ;
which latter was thenceforth embodied in the former, after hav-
rT
ing continued from the year 1819.
7. Medicinische Zeitung herausgegeben, von dem Verein fir
Heilkunde in Preussen. }
This Journal is especially worthy of attention. I know none
more valuable. It appears in folio form, and contains four or
six pages. It is published weekly, and is edited by Dr. Hecker,
the author of the well known history of the Black Death in the
fourteenth century. It is very cheap, the subscription for the
whole year amounting to three dollars, and two thirds of a dol-
lar. It is dedicated to surgery as well as medicine, and con-
tains notices of the chief works published in Germany.
8. Journal der Chirurgie und Augenheilkunde, von C. ¥’. Von
Grafe, und P. H. Von Walther.
This has long enjoyed a considerable reputation in Britain,
where late occurrences have contributed to spread the surgical
and ophthalmic fame of Grafe. It is published every second
month, and commenced in 1820. Each number costs one
dollar.
9. Journal fur die Opthalmologie, von F. A. Von Ammon.
This is a Journal devoted exclusively to ophthalmic surgery,
but which I have never seen. Two volumes, each consisting of
four parts, and costing three dollars, appeared in the course of
three years.
10. Journal fir Geburtshilfe, Frauenzimmer, und Kinder-
krankheiten, von Ki. C. J. Von Siebold.
This enjoys, and most deservedly, a very high reputation,
and is, as its title implies, exclusively devoted to midwifery, and
the diseases of women and children. It was commenced in
1809, by Siebold, the father, under the title of Lucina, which
was changed to the present title in 1827. After the elder Sie-
bold’s death, the work was continued by his son, formerly Pro-
fessor at Marburg, but now at Gottingen. Each number costs
one dollar. It is published at long intervals.
As we have in Britain no periodicals dedicated exclusively
voL. v. No. 14. | 20
280 Bibliographic Notices.
to midwifery, I have thought it well to add the titles of two
others published in Germany.
Gemeinsame deutsche Zeitschrift fiir Geburtskunde, heraus-
geben, von W. Hi. Busch, L. Mende, und F’. A. Rittgen.
A volume consists of four numbers, and costs one dollar and
a half. The numbers appear quarterly.
Annalen der Klinischen Anstalten der Universitat zu Berlin
fir Geburtshilfe, Krankheiten der Weiber und Kinder, von _
Professor Betschler.
Rosert J. GRAVES.
SCIENTIFIC INTELLIGENCE.
CHEMICAL AND PHYSICAL SCIENCE.
Spark during the Freezing of Water by Aither.—M. Julia
Fontenelle states that M. Pontus, Professor at the Royal College of
Cahors, has communicated to him the following observation. It is
well known to chemists that if a phial, terminated by a small tube
one to two centimetres long, be filled with water as well as the tube,
and surrounded with cotton moistened with zther, the water freezes
during the evaporation of the ether under the receiver of the air-
pump. On repeating this experiment, M. Pontus remarked, that
some moments before the congelation occurs, a spark, visible in day-
light, escapes from the small tube which terminates the phial. This
phzenomenon is so generally true, that every time that he perceived
the spark, he concluded the congelation was about to take place; and,
on the contrary, when he did not see it, he presumed that the con-
gelation was not near. M. Pontus was never disappointed in his
conclusions. M. Fontenelle states that he also has seen the spark,
and that M. Becquerel had remarked to him a similar effect at the
moment of the formation of crystals in solutions.—Lond. and Ed.
Philosoph. Mag. and Jour. of Scvence.
Test for Hydrocyanic or Prussic Acid, and Method of appre-
ciating the Quantity.—We are informed by Mr. John T. Barry that
the nitrate of silver, in common with other salts of that metal, is so
extremely delicate a test of the presence of hydrocyanic acid, that
its detection is not difficult in a drop of water containing far less than
the ten thousandth part of a grain of that poisonous agent. For
instance, if one minim of the dilute medicinal solution be mixed
with a pint of water, its presence may be demonstrated in a single
drop of the mixture. But what is of more consequence is, that al-
though the mixture be contaminated with various organic substances,
such as those contained in articles of diet, milk, coffee, tea, porter,
wine, and soups, so far as is yet known the test retains its sensibility
unimpaired. Mr. Barry, however, thinks that this extreme sensi-
bility, while it renders the evidence of the silver test conclusive as to
the absence of prussic acid, will be of more limited service in estab-
lishing its presence, for, without adverting to the possibility of other
volatile substances being hereafter discovered to have a similar effect
282 Scientific Intelligence.
on solution of silver, it is to be borne in mind that this reagent indi-
cates the existence of prussic acid in some esculent substances where
it had previously been found, as well as in some new ones. Upon
this branch of the subject medical jurists will probably think it right
to collect information.
The application of the solution of silver is simple. The suspected
fluid is to be acidulated by the addition of acetic acid, but so as to
redden litmus paper in only the slzghtest degree. If excess of acid
be already present, it is to be not quzte neutralized by carbonate of
soda. These precautions are adopted to retard the interference of
ammonia or muriatic acid. Two or three drops, quite cold, are then
put into a watch glass, and immediately covered by a plate of glass,
whose under-surface, to the breadth of a pea, is moistened with so-
lution of nitrate of silver, formed by dissolving one grain lunar caustic
in 100 grains distilled water :—
If the inverted drop of silver solution retain its transparency un-
altered, the absence of prussic acid is established; for had it been
present, the silver solution would in a few moments have become
clouded by the formation of a whzte precipitate, an effect which,
indeed, is almost instantaneous when the prussic acid is not exces-
sively diluted. If, on the other hand, the precipitate appear, the
conclusion must not be drawn that it is cyanuret of silver, until iden-
tified as such by two properties :—first, its speedy re-solubilzty, as
denoted by the clouded drop becoming again clear, when placed
over a vessel of caustic ammonia, in which respect it differs from the
silver compounds of iodine and bromine :—and secondly, in retain-
ing unchanged its pure white colour after exposure a few minutes
to the sun’s rays, or for a longer time, to day-light. As this pro-_
perty essentially distinguishes it from the compound of silver with
chlorine, it is important to establish it by a separate experiment
upon a somewhat larger portion of the precipitate, which should be
obtained, by candle-light, by successively placing the inverted drop
of nitrate of silver over renewed portions of the liquid in a saucer :
as soon as the precipitate separates into distinct curd-like particles,
it is ready for exposure to the solar rays.
Another property which distinguishes the cyanide (or cyanuret)
of silver from the chloride, is, that upon being ignited in an open
sbort glass tube, the cyanogen burns with a flame of the usual
colour, leaving the metal pure, if sufficiently heated,—a quality the
more valuable as it furnishes an index to the proportion of prussic
acid it represents, which upon ordinary occasions may be estimated
as equal to one fourth the weight of residual silver.
When, acting upon this principle, it is desirable to ascertain the
entire quantity of prussic acid, it is to be obtained by slowly dis-
tilling over, in nearly filled close vessels, about an eighth of the
acidulated mixture under examination; rectifying it; re-acidula-
ting by acetic acid; precipitating by slight excess of nitrate silver ;
washing with distilled water, only so long as the washings affect
Scientific Intelligence. 283
litmus paper; drying at 212°; weighing:—and lastly, igniting and
re-weighing.
The medicinal solution above referred to (as to be diluted for ex-
periment in the proportion of one drop to the pint of water) con-
tains, in round numbers, nearly a sixteenth of its own weight of an-
hydrous prussic acid, or rather less than four grains in the drachm,
being the article (commonly designated ‘ of Scheele’s strength,”’) as
manufactured by some respectable houses in London. We under-
stand that Messrs. William Allen and Co., by means of silver as a
reagent, have uniformly concentrated it to this degree since the
year 1820, when Mr. Barry introduced the use of that metal to de-
termine and regulate its proportion of absolute prussic acid by the
formation of cyanuret of silver. The method being one which ad-
mits of extreme precision, will deserve the attention of the College
of Physicians, if prussic acid be inserted in the next Pharmacopeeia.
It is to be recollected that this preparation, like those of alcohol or
esther, is subject to variation, notwithstanding any superiority of
formula, or care on the part of the operater. Hence the necessity
of means for assaying the final product and for reducing it to a uni-
form standard. With regard to the employment of cyanuret of po-
tassium for the occasional formation of hydrocyanic acid, it is a
question which at least deserves very serious consideration. Its dis-
position to absorb atmospheric moisture, and always to become more
or less converted into carbonate, while its cyanogen (united to hy-
drogen,) to an uncertain extent is dissipated, especially when this
beautiful salt is much disintegrated, constitute formidable difficulties.
But a still greater objection will present itself at the counters of
apothecaries and chemists where medicines are made up, from the
possibility of this intensely poisonous salt being sometimes mistaken
for other substances, in the frequent extemporaneous production of
prussic acid.—Jbid.
Extract of a Letter from Mr. William Gregory to M. Robi-
quet.— I have just examined the muriate of morphine, prepared after
our mode, by M. Duncan. That salt is of a bright whiteness, and
does not retain the least trace of narcotine. I operated on two kil-
ogrammes after your method for the codeine, and from that quantity
1 obtained two ounces of the hydrated codeine perfectly soluble in
ether and in water. I found in it all the properties so well developed
in your last work ; having thus at my disposal a considerable quantity
of that new substance, I thought it right to make some experiments on
its therapeutic properties. I prepared the crystalized nitrate, some of
which I took myself, and several of my students who wished to try
the effect: a dose of three grains had no effect on either of us, but a
stronger dose, of from four to six grains produced very remarkable
symptoms; first, the pulse was accelerated, great heat in the head
and face; then the spirits were remarkably excited as if by strong
liquors, an agreeable excitement which lasted some time; it was
accompanied with great itching, which commenced at the head and
284 - Scientific Intelligence.
spread all over the body ;: after a lapse of some hours, that state is
followed by a disagreeable depression, with nausea, and sometimes
vomiting. Neither of us felt any disposition to sleep, excepting
after the depression. We did not try a larger dose, but it appears that
the codéine possesses a stimulant effect, and produces violent itching
in a dose of five grains. Such is the ordinary progression of symp-
toms which it produces, but in some its effects, especially in the state
of depression, are very disagreeable.
‘« After these experiments it is not probable, as you have supposed,
that the presence of the codéine is the cause of the superiority of the
ordinary muriate of morphine. As one-fourth of a grain of that
latter salt is sufficient for a dose, and only contains one-thirtieth of
its weight of codéine, and of which three or four erains are required,
the effect cannot be attributed to the codéine. It remains to find
out if the muriate, deprived of codéine, is less stimulating on that
account, and if it does not cause the same itching I have seen often
‘produced by the non-purified muriate, and also by the opium, in a
ereat number of cases: it is a point which ] purpose examining
hereafter.
“Tf you believe these remarks can interest the Society of Pharmacy,
have the goodness to communicate them—perhaps some of the mem-
bers will be curious enough to repeat them with the codeine which
you have prepared. I should have added, that in two or three cases
the codéine produced a slight purgative effect, while in others it was
inert in that respect.”’ |
I had also said that morphine was far from representing the es-
sential properties of opium, and that they probably completed it :
the observations of Mr. William Gregory confirm, in a great measure,
my ideas.’ But it is remarkable that that able chemist only employed
the codéine in the form of nitrate, and the experiments of M. Kunkel
have shewn, that the codéine loses much of its action when it is
combined with acids. It is then to be presumed that in employing
that new alcaloid in simple aqueous solution, the effects will be much
more marked than those observed by Mr. Gregory.—RosiquetT.—
Journal de Pharmacie, Feb. 1834.
On the Rotatory Movements of Camphor, by Mr. Charles
Mattucci.—In studying the phenomena of rotation which’ small
pieces of camphor presented on the surface of water, M. Mattucci has
shewn, by direct experiment, that it is the current of the vapour
produced by that volatile substance which causes the rotation, and not
the development of electricity, as some persons have supposed. That
physician has remarked, that in placing the vessel where the pheno-
menon of the rotation of a large piece of camphor was scarcely per-
ceptible in the open air under the pneumatic machine, its movement
became more rapid as soon as the air was rarefied, and that it stopped
when they ceased to extract the air. He observed all these pheno-
mena of rotation on the water’ in’ all solid volatile bodies, or -those
Scientific Intelligence. 285
impregnated with a volatile substance. | For example, in placing cork
filings impregnated with sulphuric ether on the water, they will turn
very rapidly like small pieces of camphor; and if it is wished to con-
tinue that rotation for some time, one end ofa piece of thread my
be dipped in zther, and the other end brought in contact with the
surface of the water: in this manner the ether will descend as by a
syphon, and the movement will be prolonged.-—Journal de Chem.
Med, Feb. 1834. :
NATURAL HISTORY.
Extract from a Paper read by Dr. Houston, at a Meeting of
the Zoological Society of Dublin, on the Diseases of the Animals
which died in their Collection.—Among the animals of the class
Mammalia, the causes of whose death I have ascertained by dissec-
tion, are several of the monkey tribe, a Samber deer, and a Virginia
deer.
Of birds I have made some interesting observations on the dis-
eases which have deprived us of an eagle, an ostrich, and a macaw.
Respecting the monkeys, I have had opportunities of examining
the bodies of a great number of this tribe of animals, and I cannot
charge my memory with a single case, in which the animal had not
either died of consumption, or, having lost its life from some other
cause, did not present marks of incipient phthisis in its lungs, and
generally evidences of the same scrofulous disease exhibited them-
selves simultaneously in many other organs of the body, such as the
liver, spleen, lymphatic glands, kidneys, uterus, brain, &c.
In the little animal which every one must have seen in the streets,
riding as a soldier on the back of a dog, and which died lately,
leaving its proprietor pennyless, one of the lungs was completely
gone, and the other far advanced in disease. In some parts, small
recent tubercles were found.—(Here Mr. Houston explained the
nature of tubercles.)—And in others tubercles of longer standing ex-
isted, as evidenced by their size, and conversion into a white cheesy
matter, One of the lungs was also universally adherent to the inside
of the chest, and motionless. Rudiments of the same disease had
commenced in the liver and spleen.
In the animal which last died in the gardens, the Barbary ape,
the lungs were filled with small tubercles, not, however, in so ad-
vanced a state as in the animal last alluded to. The lymphatic glands
behind the roots of the lungs and heart, were very much enlarged ;
their structure totally changed, and their interior occupied by masses
of scrofulous matter. By their size and number, they surrounded,
and inconyenienced the operations of the great blood-vessels and
eesophagus or gullet. The liver was studded, throughout, with nu-
merous incipient points of the disease; the. spleen was so changed
by it, as to have been rendered incompetent.to the performance of
I86 Scientific Intelligence.
its natural functions. The glands of the mesentery were enlarged,
constituting the disease, which in children is called tabes mesenterica.
The structure of the uterus was every where occupied by round,
soft, and white tumors; and one of the kidneys had taken on a simi-
lar diseased action. I have preserved in the Museum of the College
of Surgeons, a specimen, showing extensive disease of the same
kind in one of the hemispheres of the brain of a monkey; and I have
noticed, in another case, ulcers on the lining membrane of the intes-
tines, in connexion with a tuberculated condition of the glands about
those organs. In contrasting the scrofulous disease acquired by these
animals while resident in our climate, with that which affects human
beings, (for the disease in both is exactly the same,) my observations
would tend to the conclusion, that, in the former, the scrofulous taint
spreads itself more generally over many tissues and organs, destroying
the animal rather by its universality than by concentrating itself, and
causing great alterations of structure in any one organ ; whilst in the
latter, it confines itself more usually to one organ, the lungs, and
causes death by the production of such changes therein, that their
all important functions are annihilated. In none of the monkeys
dissected by me, had the disease of the lungs reached beyond what
are considered the first and second stages of it in the human body.
In none were the tubercular deposits in any other form than that of
small, circumscribed, soft tumors, without the presence of much pur-
ulent matter for expectoration; the animal appearing to have died
from the general febrile state induced by lurking disease in so many
parts of the body, rather than from privation of air, on account of
the incapacity of the lungs to receive it; whereas it is, to medical
men, a matter of every-day observation, to find the lungs of persons
dying of consumption, converted into great cavities, which discharged,
during life, enormous quantities of matter, and by occupying the
place of sound lungs, almost deprived the individual of breath.
We may now allude to the post mortem examination of the Sam-
ber deer, the death of which was a source of much regret at the gar-
den. The animal had been a considerable time ailing—it had eaten
badly, and lost flesh—but further than this no suspicions were enter-
tained of its being dangerously ill, until a few days before its death,
when it contracted a cough, appeared weak, and much disposed to lie
on its litter, while at the same time its restlessness indicated the pre-
sence of pain. On examination, the cause of death was found to be
in the lungs, which exhibited marks both of the recent disease of
which the animal died, and traces of the former alterations in struc-
ture, on which its previous delicacy depended. The latter were ex-
hibited in a solidified, tuberculated state of the lower part of the lungs
on both sides. The former were evinced by engorgement in the right
lung, and effusion of lymph in the pleura. The animal had had disease
of both lungs of long standing, and was killed by a recent attack of
pleuro-pneumony of the right. No other disease was found in any part
of the body except a caries of the lower jaw on the right side, near the
articulation, an affection, the presence of which may account for the
Scientific Intelligence. Ie7
difficulty of chewing, which had been observed in the animal for a
considerable time previously to death. The heart, the intestines, and
all the other organs appeared in a sound state. We should learn
from the facts here stated, to pay particular attention to animals
which happen to be in any way indisposed, because, as in the human
constitution, the more delicate the frame, the more susceptible is it
of inflammatory attacks, and the more care is necessary for its preser-
vation. Indeed, so far as I can recollect, the death of the Samber
deer occurred in the beginning of last winter; when, with lungs ina
previously delicate state, and highly susceptible of aggravation of the
disease under which they laboured, from causes which in the natural
state would not be felt by them; most probably some cold, accidentally
taken, may have been the cause of the recent malady.
The Virginia deer, the beautiful little animal which used to at-
tract so much attention by its familiarity, in jumping about the visi-
tors, and taking bread off the hand which presented it, met its death
by being gored by the hog-deer. In this animal no traces of disease
could be found in any organ in the body. The liberty which was al-
lowed it on account of its harmlessness, secured for it natural exer-
cise, and might have preserved it alive for a long period, had not the
misfortune before mentioned occurred to it.
A golden eagle, in a state of apparent good health, became sud-
denly ill, and died after a lapse of a few hours, as if in a fit of suffo-
cation. No disease was found in any part of the body, except the
windpipe, which gave evidences of the most rapid and violent inflam-
mation. The interior, near the lower larynx was red, and covered
with a coating of lymph, which adhered loosely to the lining mem-
brane, and was in such abundance as nearly to block up the passage
and obstruct the entrance of air. . The disease was like croup in chil-
dren, called the pip. The lower part of the larynx in birds, Mr.
Houston observed, is the part where the sound is produced—in man,
it is the upper part : the bird was affected in the lower part of the la-
rynx, children are affected in the upper part. The next case is, that
of a young Solan goose, (Anser Bassanus), which died of a very
singular affection. It had pined away during weeks ; refused food,
and died. The windpipe was sound. The air cells all through the
body were in a state of chronic inflammation thickened; coated with
lymph ; white and moist in some places; in others dry, green, and
blue, moulded from the air. The cells around the heart and great
vessels, in arm bones, about the liver, and all through the abdomen,
were in this state. The texture of the lungs was otherwise sound;
there existed no tubercles.
The female ostrich received the stroke ofa branch in the left
eye. The eye swelled greatly, was protruded from the socket, red,
and discharging matter. The animal was pining away ; its limbs
were wasted and pale; its feathers dropped out, and it could not be
got to eat. Under the impression that a collection of matter had
formed in the interior of the eye, and was prevented from getting
out by the thick tissues, (and satisfied that the sight of the eye was
VOL. V. No. 14. 2 P
288 Scientific Intelligence.
for ever lost,) I made an incision through and across the cornea with
a lancet, and gave exit to the pent up discharge, which, by the pain
and fever it produced, was acting so deleteriously on the health of
the bird. After this the eye sunk back into its socket, though re-
taining its natural fulness. It gradually healed over; and the
animal, though deprived of sight in that eye, is now much improved,
and promises soon to be restored to health.
The death of the macaw was caused by a round, firm, whitish
tumor, which grew in the coats of the intestine, about a foot and a
half from the cloaca, and obstructed the passage through the bowels;
the part of the gut above the tumor was distended with alimentary
matter in a semifluid state, and appeared thick and large ; that below,
which naturally is the widest part, was small, attenuated, and empty.
Similar diseased tumors were found in the liver and spleen. The
skeleton also presented a specimen of the reunion of broken bones ;
one thigh and tibia having been fractured at some former period, and
strongly, though not very elegantly, repaired by irregular masses of
callus.
But the most interesting part of the examination of this bird was
connected with the stomach.
The following is a description of the ewsophagus, stomach, and
intestines of a macaw (macaceros macao). The esophagus is short
and wide; the crop large, thin, dilatable, and vascular; the ventri-
culus succenturratus is thick and glandular, and large and stomach-
like where it joins the gizzard; the gizzard is not bigger than a
good sized hazel-nut, and has more the appearance of a knobby ap-
pendix to the enfundzbulum, than a part of the organ from which
much assistance could be derived in the process of digestion.
Most probably in this bird, which was very old, and had been a long
time domesticated and fed chiefly on pap, the condition of the sto-
mach had been changed from that which in the natural state adapts
it for bruising the husks and shells of fruits, to that more suitable
for the chymification of soft and digestible materials. The intes-
tines are long and without ceca. This singular transformation of an
organ into one of a different type, on account of a change in its appli-
cation to the purposes of digestion, is peculiarly interesting in a phy-
siological point of view. We have here, without design, without
any pains-taking on our part, and without any cruelty to the animal
in question, an illustration of a fact respecting the stomach, for the
establishment of which a great variety of experiments were insti-
tuted. It is a transformation exactly analogous to that effected by
the celebrated physiologist, Duhamel, in the stomachs of pigeons, by
feeding them solely on animal matters. The gizzard of the grani-
vorous bird (the pigeon) underwent a species of metamorphosis—it
was converted into the membranous stomach, peculiar to the bird
whose natural aliment is flesh,
Scientific Intelligence. 289
ANATOMY AND PHYSIOLOGY.
Analysis of a Memoir on the Mechanism by which ihe Sounds
of the Heart are produced, read to the Academy of Sciences of
Paris, 3rd of February, 1834, by M. Magendie. (First part).—
Laennec is the first who paid special attention to the study of the
particular sounds of the heart, in the discharge of its function of
keeping up the circulation. To him we are indebted for knowing,
that during the natural performance of this function, the heart causes
to be heard at each of its pulsations two successive, well-marked
sounds, called, by reason of their particular physical characters, the
dull sound and clear sound. But neither the mode in which the
production of these sounds is explained by him, nor the explanations
given of it since his time, are, or ought to be admitted. According
to Laennec, the dull sound is preduced by the contraction of the ven-
tricles at the instant that the blood is sent into the aorta and pulmo-
nary artery, the clear sound depending on the contraction of the au-
ricles : the source of both the one and the other to be referred to the
sonorous vibrations, developed in the muscular fibres of the heart, at
the instant when they contract.
But to this explanation it may in general be objected, Ist, that it
is founded on deductions drawn from the time and place where each
of these sounds peculiar to the heart are more especially produced,
and not on direct observations ; 2nd, that the production of the sound
by the contraction of the muscular fibres of the heart, is a supposition
quite gratuitous; 3rd, that even admitting it, we cannot understand
how the ventricles of the heart, distinct in their situation, and diffe-
rent in their structure, should move constantly with such harmony,
as never to produce but one single sound; 4th, neither can we un-
derstand, how in certain cases, these sounds cease altogether, the
heart still continuing to act and to keep up the circulation; whence
it would follow, that there are sonorous contractions, and others that
are not so, &c.
Professor Turner, in a paper inserted in the third volume of the
Transactions of the Medico-Chirurgical Society of Edinburgh, has
particularly objected, that the clear sound cannot be attributed to the
cause assigned by Laennec, seeing that the venous pulse of the jugu-
lars, which depends in a great measure on the contraction of the au-
ricles, presents no coincidence with this sound, which, however,
should happen, if they had the same origin. But he does not him-
self offer any explanation of the phenomenon, declaring that he
knows none.
In 1830 and 1831, Doctor Hope, relying on numerous experi-
ments, still further objected; Ist, that the contraction of the auricles
precedes the dull sound of the heart; 2nd, that this contraction is not
accompanied by any sound ; 3rd, that the clear sound of the heart co.
incides with the dilatation of its ventricles. And substituting ano-
290 Scientific Intelligence. ;
ther explanation for that of Laennec, he refers the two sounds of the
heart to the sudden displacement which the blood undergoes, either
in entering the ventricles, or in its exit from them. But this expla-
nation, devoid of proofs, is itself exposed to the strongest objections.
Likewise since Dr. Hope’s work, other explanations have been pro-
posed. Sometimes the souuds have been attributed to the shock of the
blood against the parietes of the ventricles at the moment of their di-
latation. Sometimes they have been made to depend on the shaking
of the aorta and pulmonary artery, under the influence of the blood
driven forwards by the ventricles. More recently M. Ronanet, in
his inaugural dissertation to the faculty of Paris, endeavoured to
prove by a series of arguments and some experiments, that these
sounds are owing, the one to the shock given by the blood on the
tricuspid and mitral valves, the other to the shock of the blood on
the sigmoid valves of the aorta and pulmonary artery.
In this question the first point, as we see, is to examine whether
the sounds of the heart are developed in the organ itself, as was sup-
posed by all the physicians who endeavoured to discover their origin,
or whether they have any other cause. ‘It is with this view,” says
M. Magendie, “ that I first instituted the following experiments :
“ First experiment. [ listened to the heart, when exposed in a
living animal, still keeping up by its alternate movements the circula-
tion of the blood. The experiment first made, and several times re-
peated on small animals, was afterwards made on larger animals, dogs,
horses, and every time the heart was exposed and insulated, the
sound entirely ceased.
“ Second experiment. As mammiferous animals survive only a
short time after removing the anterior part of the thorax, and the ce-
lerity with which the observation should be made, may give rise to
error, I wished to repeat the experiments on birds, where the sounds
of the heart are well developed, and in whom it is possibie entirely to
remove the sternum without immediately destroying life. When in-
stituted on geese, the experiment yielded me the same results.
‘Thus, I at first attained the certainty, that the sounds of the
heart are not developed in the organ itself, that is to say, that they
do not arise from the respective play of its different cavities, no more
than from the action of the heart on the blood, or of the blood on the
heart.”
This point settled, the question is to discover the true origin of
these phenomena.
‘“‘ Third experiment. 1 had the idea,” continues M. Magendie,
‘¢ that the sounds of the heart might be produced by the well known
beating of this organ against the parietes of the chest, and I saw no
physical reason which could make me reject this idea. On the con-
trary, I could not understand how a shock on an elastic parietes, such
as the thorax is, should not be sonorous. To verify my conjecture,
having laid bare the heart in several living animals, I exposed sono-
rous bodies to its impulse during the systole of the ventricles. Every
Scientific Intelligence. 29}
time these shocks produced distinct, and sometimes very intense
sounds, which varied also according to the nature of the body that
was struck.
‘< Fourth experement. raised with the greatest care the ster-
num of a goose; immediately the sounds of the heart ceased, as I al-
ready stated: then I replaced the bone in its natural position; and
immediately the sounds recommenced, such as they were before the
experiment. By raising and replacing the bone, I could easily sus-
pend and produce the sounds. |
‘“< With these experiments the following facts are connected:
‘* Ist. In certain animals whose chest is spacious, and the mem-
branous attachments of the heart flexible, as happens in that species
of dog called the Spanish pornter, it is sufficient to make them lie on
the back, and thereby separate the heart from the thoracic parietes,
when the sound ceases forthwith, recommencing again when the
animal resumes his ordinary position.
‘¢ 2nd. Air or water introduced into the chest by pushing back
the heart towards the vertebral column gave the same results, so that
the animal subjected to this experiment presents no sounds of the
heart, though that organ contracted regularly.
‘* 3rd. Even in man when there exists any mechanical obstacle in-
terposed between the heart and the thorax, the sound of the heart
ceases in the same way.
‘*Thus I acquired in the second place a certainty, that the
sounds of the heart were produced, conformably to what I had con-
jectured, by the shocks of this organ against the parietes of the
chest.”
This point being settled, it still remains to find the cause of the
difference of the two sounds.
** Fifth experiment. J introduced a slip of metal, thin and flat,
into the thorax of a dog, so as to prevent the shock of the apex of
the heart against the thoracic parietes; immediately the dull sound
ceased. The efforts of the heart on the metal plate were perceptibly
violent, and if I ceased for a moment to press on the heart, the sound
recommenced, the apex of the organ striking against the parietes of
the thorax.
‘‘ Air or water injected into the left pleura, so as to keep the
heart at a distance from the wall of the thorax, yielded me a similar
result.
“« Sexth experiment. The same metal plate being laid on the an-
terior surface of the right ventricle, so as to keep it at a certain dis-
tance from the sternum, the clear sound ceased immediately, to com-
mence again the moment the plate was withdrawn. Thus I again
attained the certainty, that the dull sound of the heart is evidently
the result of the shock of the apex of this organ against the chest; a
shock which is designated for time immemorial, by the excellent
name of pulsation of the heart, (battement du ceur), and that the
clear sound is caused by the shock of the anterior surface of the right
ventricle against the posterior surface of the sternum, and the neigh-
292 Scientific Intelligence.
bouring parts of the thorax on the right side, at the moment of the
dilatation of the ventricles.
‘¢ With respect to this double shock of the heart on the thorax,
the one at the instant of the contraction of the ventricles, the
other at the moment of their dilatation, it was proved to me by a
considerable number of direct observations made on living animals.
li is also easy to verify it in man, in certain cases of hypertrophy of
the ventricles; for if two stethoscopes be placed simultaneously on
the chest, the one opposite the apex of the organ, the other on the
lower and left part of the sternum, with a little attention we dis-
tinctly perceive the two instruments violently raised at a very short
interval, and perfectly isochronous with each of the sounds of the
heart.
‘To sum up, here then, if I am not mistaken, is the true me-
chanism of the normal sounds of the heart : .
‘Tn contracting, and for causes long since known, the ventricles
throw the apex of the heart against the left lateral part of the thorax,
and thus produce the first sound, 1. e. the dull sound.
‘© In dilating in a great measure under the influence of the rapid
(brusque) influx of the blood, the heart gives a shock to the anterior
parietes on the right of the thorax, and thus produced the second
sound, the clear sound.
‘This explanation, conformable to the general laws of acoustics,
and which will henceforward, | trust, form a new point of contact be-
tween medicine and physics, is so simple and so natural, that one
might ask how it did not come into the mind of physiologists at first,
did we not know that in the sciences, as in other matters, simplicity
and truth very rarely present themselves in the first instance to our
imagination.”
But because, if this explanation is the true one, it ought to ac-
count for all the particular circumstances connected with each of the
sounds of the heart, M. Magendie will examine this question in the
second part of his memoir.—L’ Institut. Journal General des So-
cietes, &c. Feb. 1834.
Discovery of Lymphatics in the Human Placenta and Funis,
by Dr. V. Fohmann.—It is well known that the placenta and funis
rank foremost among those parts in which the presence and distribu-
tion of absorbents have not yet been duly recognized. Some anato-
mists, certainly, such as Everhard, Pascoli, Needham, and Roslin,
who are cited by Schreger,* as also Wrisberg,t and Uttini,{ insist
* De Functione Placenta Uterine, ad virum illustrem S. T. Sommering Epis-
tola. Erlange, 1799.
+ Michaelis Observationes Circa Placente ae Funiculi Umbilicalis vasa Ab-
sorbentia. Gottinge, 1790.
+ Ueber die Einsaugenden Gefasse des Mutterkuchens ; in Meckel’s Archiv.
vol, il.
Scventyfic Intelligence. 293
that they have seen absorbent vessels in these parts; but little reli-
ance was placed on their observations, because men of great repu-
tation, such as Hunter, Hewson, Cruikshank, Mascagni, and others,
had in vain endeavoured to demonstrate them. Moreover, as, after
the establishment of Hunter’s doctrine of absorption by the lymphatic
vessels, new experiments were made which appeared to favour the
theory of absorption by the veins, and the attempts to discover ab-
sorbents in the placenta and funis were unsuccessful, these parts
were, without farther consideration, declared to be unprovided with
absorbents, and were even employed as a proof of absorption by the veins,
It was maintained that venous absorption was not only proved by nu-
merous experiments on live animals, but also by those parts which,
though not provided with absorbents, were yet organs, such as the
placenta, eye, &c. in which the existence of an active absorption
could not be denied. Now, in this, there was evidently a false con-
clusion. The fact that absorbents have not been found in certain
organs does not prove their non-existence in those organs, but only
that we have not been able to discover them. In general, physiolo-
gists relied too much on superficial examination of these vessels, and
were thereby led into many errors. Thus Magendie contested
Monro’s and Hewson’s doctrine of the presence of absorbents in all
the vertebrata ; and still denies the existence of vasa chylifera in
birds. Fishes and amphibia have a perfect absorbent system; the
intestinal canal of birds, and many other parts said to be without
absorbents are plentifully provided with them ; and the placenta and
funis are, as we shall prove, in the same predicament.
The funis consists, its blood-vessels excepted, of a tissue of ab-
sorbents, which is so close that the point of a needle cannot be in-
troduced into any part of it without wounding one. Nothing can be
easier than to inject them with mercury. Had the anatomists who
asserted that they observed absorbents in the funis, been rightly
aware of their situation, it would have been easy for them to con-
vince their opponents of the truth of their statement by ocular de-
monstration. To fill them with mercury, nothing more is necessary
than to pierce the sheath with a small lancet, and then inject the
metal through a fine tube. As a great many vessels are necessarily
wounded in this operation, and the mercury, on entering one branch,
gets into others through numerous anastomoses, it is evident that the
experiment must easily succeed. It must here be remarked that the
filling of the absorbents of the funis is the more readily accomplished,
the fuller it is of the <qguor Whartonz ; which no doubt arises from
the fact that that fluid distends the vessels (absorbents) in which it is
contained, and consequently favours the entrance and advance of the
mercury. For the rest, it would be vain to endeavour to discover in
the funis and placenta absorbents provided with valves, as Wrisberg
pretended he saw, or as we find them after leaving the venous organs
of the body. The absorbents of these temporary structures do not
attain to such a degree of development, but are circumstanced as
they are in the parenchyma of the organs: that is to say, they form
a
294 Scientific Intelligence.
tissues and net-works, of which the branches are valveless, so that
mercury injected into any one can proceed in all directions.
If we wish to enter minutely into the examination of the ab-
sorbents of those parts, by means of which the communication be-
tween the mother and foetus is maintained, we have to consider tiose
vessels as they exist in the placenta and funis, as well as their pas-
sage into the body of the foetus, and their distribution therein. The
funis, its blood-vesséls excepted, consists solely of a tissue of ab-
sorbents, as has been already mentioned. The larger ones occupy
its axis, while the smaller ramify towards the surface, and are
at last lost in the sheath. The cells or vesicles usually observed in
the funis, are shown by injection to be dilatations of the absorbents,
into which branches from the placental side open themselves, and
continue their course to the foetus on the opposite side. The ab-
sorbents of the funis become perceptibly finer at each of its extremi-
ties, and especially where they enter the cutis at the umbilicus.
But before I proceed further with the description of them in that
situation, I must relate what I have observed of them in the pla-
centa.
By injecting with mercury the tissue of absorbents at the pla-
cental extremity of the funis, and driving the metal towards the
placenta with the handle of a scalpel, we may sometimes succeed in
injecting a net-work of absorbents that is spread out between the
placenta and its investing membrane. I never saw any vessels
rising from this net-work and ramifying into the membrane, (the
chorion,) as has been observed with respect to the sheath of the
funis; and I but seldom discovered any branches penetrating the
parenchyma of the placenta. Where they proceed when they do pene-
trate, I have not been able to make out; but I am inclined to think
they reach its uterine surface.
On the passage tissue of absorbents of the funis into the ab-
dominal region of the foetus, the superficial ramifications at the dis-
tance of a few lines from the umbilical ring, become so very minute
as to be scarcely discoverable by a strong lens, even when injected
with mercury. On the other hand, the deeper seated vessels gain in
strength while they lose in diameter ; so that we can employ the handle
of the scalpel to drive the mercury on through them without any
fear of their rupture. On reaching the umbilical ring, {they become
somewhat larger; and some of them run into the dense tissue of ab-
sorbents between the epidermis and cutis, of which, the sheath of
the funis is only a continuation. The rest unite into branches,
which proceed under the cutis, and at the distance of some lines
from the umbilical ring generate a lymphatic trunk, which running
‘n acircular direction, forms another ring. This gives off branches
which, following the external abdominal veins, descend between the
cutis and the muscles to the inguinal region, and pass under the
crural arch to the iliac glands. I have invariably observed this dis-
tribution; but 1 have sometimes also found lymphatic branches be-
neath the abdominal muscles, proceeding from the funis through the
Scientific Intelligence. 2935
umbilical ring, and following the vein or arteries into the porta of the
liver, or else running to the glands which receive the vessels that de-
scend without the abdominal muscles.— W. West.
_ Observations on the supposed Vision of the Blood-vessels of
the Eye, by Sir David Brewster, LL.D., F.R.S.*—In the Number
of this Journal for September, 1832, I had occasion to refer to the
remarkable experiment described by Dr. Purkinje of Breslau, in
which the blood-vessels of the retina are supposed to be exhibited ;
and though I had in vain tried to see this phenomenon, yet it had
been so accurately described to me by Mr. Potter that I ventured to
give an opinion respecting its cause. The paper which contained
this explanation was read at the Physical section of the British As-
sociation at Oxford, in June, 1832, and Mr. Wheatstone, who was
present, favoured the Meeting with some excellent observations on
the subject. These observations have been printed in the Report of
the Association, for 1832, in the form of an Appendix to the abstract
of my paper; and as they are highly interesting, and will form the
groundwork of the following observations, I shall give them ver-
batim.
‘‘ After the reading of Sir David Brewster’s paper, Mr. Wheat-
stone said, that having been the first person to introduce Purkinje’s
beautiful experiment into this country, and having repeated it a great
number of times under a variety of forms, he would take the oppor-
tunity of stating a few particulars respecting it, which appeared not
to be generally known. The experiment succeeds best in a dark
room, when, one eye being excluded from the light, the flame of a
candle is placed by the side of the unshaded eye, but so as not to
occupy any of the central part of the field of view. So long as the
flame of the candle remains stationary, nothing further occurs than a
diminution of the sensibility of the retina to light; but after the
flame has been moved upwards and downwards, through a small
space, for a length of time, varying with the susceptibility of the in-
dividual on whom the experiment is tried, the phenomenon presents
itself, The blood-vessels of the retina, with all their ramifications, ex-
actly as represented in the engravings of Scemmerring, are distinctly
seen, apparently projected on a plane before the eye, and greaily
magnified. The image continues only while the flame is.in motion :
directly, or soon after, the flame becomes stationary, it dissolves into
fragments and disappears.
‘¢ Mr. Wheatstone dissented from the ingenious explanation of
this appearance offered by Sir David Brewster, and also from that
- opinion stated to be the generally received one; and begged to repeat
the solution he had published, and which he had not since been induced
to relinquish, Mr. W. observed, that there was no difficulty in ac-
counting for the image; it evidently was a shadow resulting from
* See Lond. and Edinb. Phil. Mag., last Number, p. 43, and also vol. i. p. 318.
VOL. Vv. No. 14, 2a
296 Screntijic Intelligence.
the obstruction of light by the blood-vessels spread over the retina ;
the real dithculty was to explain why this shadow is not always
visible. To account for this Mr. W. adduced several facts, which
tended to prove that an object, etther more or less luminous than
the ground on which ct is placed, when continuously presented to
the same point of the retina, becomes invisible; and the rapidity
of its disappearance ts greater as the difference of luminous inten-
sity between the object and the ground is less ; but by continually
shifting the place of the image of the object on the retina, or by
making wt act intermittently on the same point, the object may be
rendered permanently visible. To apply this explanation to the
phenomenon in question, Mr. W. observed, that whenever the flame
of the candle changes its place, the shadows of the vessels fall on
different parts of the retina; which is evident from the motion of the
figure while the eye remains still, which is always in a contrary di-
rection to that of the flame. Hence the shadow, being thus made to
change its place on the retina, remains, according to the law above
stated, permanently visible ; but instantly the flame is at rest, the
shadow also becomes stationary, and consequently disappears.
‘‘ Mr, Wheatstone then exhibited an instrument for showing an
original variation of this experiment: it consisted of a circular plate
of metal, about two inches in diameter, blackened at its outer side,
and perforated at its centre with an aperture about as large as an
ordinary gun-hole; to the inner face was fixed a similar plate of
ground glass. On placing the aperture between the eye and the
flame of a candle, and keeping the plate in motion, so as to displace
continually the image of the aperture on the retina the blood-vessels
will be seen distributed as before, but will now appear brighter, and
the spaces between the ramifications will be seen filled with innume-
rable minute vessels, anastomosing with each other in every direction,
which were invisible in the former experiment. In the very centre
of the field of vision there is a small circular space, in which no
traces of these vessels appear. Mr. W. remarked, that the absence
of these minute obstructions to light will probably account for the
greater distinctness with which small objects are there seen, and also:
for the difference of colour observed by anatomists in that spot of the
retina.”
In this experiment Mr. Wheatstone has described, Ist, the com-
mon method of seeing the blood-vessels, and 2ndly, an original vari-
ation of the experiment by which the blood-vessels are seen much
more distinctly and completely.
As Mr. Wheatstone was so kind as to lend me, when at Oxford,
his plate of metal, &c., I was enabled to see the very phanomenon
which he saw, and Ihave repeated the experiment fifty times since
under many modifications. I have, therefore, no hesitation in assert-
ing that the ramifications exhibited by Mr. Wheatstone’s. apparatus
are not blood-vessels, but are nothing more than the ramifications
described in my paper already referred to. (Lond. and Edinb. Phil.
Mag., vol. i. p. 170.§ 1.) If we throw aside the ground glass in
Scientific Intelligence. 299
Mr. Wheatstone’s apparatus, and look at a luminous surface through
the circular aperture when moved as he describes, the same phee-
nomenon will be seen: and if we substitute a rectilineal aperture,
and make the line of motion perpendicular, or nearly so, to its longest
sides, the phenomena will be seen still more distinctly; and if we
look through one or more narrow slits, as in my experiment, the
effect will be the same. In short, the edges of the circular aperture
in Mr. Wheatstone’s apparatus perpendicular to the line in which
the aperture is moved, perform the part of the rectilineal slit or slits
in my experiment. Mr. Wheatstone will have no difhculty in recog-
nizing the perfect identity of the two experiments, and he will
therefore see that the ramifications are nothing more than the new
forms given to the luminous and dark parallel lines produced by the
action of light upon the retina. In order to demonstrate this, let us
use Mr. Wheatstone’s own apparatus. The general direction of the
ramifications is invariably perpendicular to the direction in which the
aperture is moved. If we change this direction from a horizontal to
a vertical line the ramifications change their direction also, so that
we can give them any inclination we please. They cannot, therefore,
be pictures or representations of any blood-vessels in the eye.
This unequivocal result would have induced me to believe that
the ramifications seen by the common method had a similar origin,
and were owing to the action of the rectilineal sides of the flame upon
the retina, had I not succeeded in seeing this phenomenon with my
own eyes: At the Observatory of Cambridge, last summer, Sir John
Herschel pointed out to Mr. Airy and myself the method by which
he saw the ramifications, and we were all successful in observing the
same phenomenon. This method scarcely differed from that described
by Mr. Wheatstone, but the ramifications which I saw were toto
celo different from those produced by Mr. Wheatstone’s apparatus :
they had not, indeed, one property in common but that of ramefyeng.
The one was seen with great difficulty and occasionally in the middle
of a brownish red light, which ded not proceed directly from the
candle; while the other was distinctly and continuously seen in the
middle of condensed light proceeding directly from the candle or
other luminous body.
Regarding, therefore, the phenomenon as real, and the ramifica-
tions as occasioned by a blood-vessel of the retina, I shall proceed to
examine the different explanations that have been given of it.
The explanation given by Mr. Wheatstone is exceedingly inge-
nious ; and the principle which he lays down, and which is printed
_ in Italics, is in every respect well founded. This property of the re-
tina, by which it is unable to maintain the continued visibility of an
object seen obliquely, or at a distance from the axis of vision, was
communicated by me to the Royal Society of Edinburgh, on the 19th
of January, 1818, and has since appeared in several elementary
works on optics; and it is a necessary corollary from the law of
oblique vision, that any movement of the object must restore its visi-
298 ~ Scientific Intelligence.
bility by removing the cause of its disappearance, namely, the con-
tinued action of the light upon the retina.
So far, therefore, Mr. Wheatstone’s explanation is unimpeach-
able: but when he states that the motion of the flame causes the
shadows of the vessels to fall on different parts of the retina, we
can no longer follow him. Unless the blood-vessel is placed at a
certain distance in front of the retina, and consequently in the vi-
treous humour, it can have no moving shadow; and, unless it is
within the refracted cone of rays which proceed from the candle, it
can have no shadow either moveable or stationary. If the shadow
here referred to, be the shadow produced from the direct light of the
candle, then the blood-vessel would appear across the visible flame of
the candle, and not at the side of it in the reddish brown light. But
independent of these objections to the application of the optical prin-
ciple previously laid down, there are two facts which appear to be
conclusive against the explanation: the one is, that the blood-vessels
of the retina are not at a distance from it; and the other, that the
ramifications may be seen distinctly when the candle is not in motion.*
There is one objection more to this explanation, which appears to me
a formidable one: the ramifications ought to be distinctly and readily
‘seen when the light which forms the shadow is reduced to the same
state of dilution, and the same colour, as the reddish brown light on
which they appear. This experiment I have repeatedly made with
light of all degrees of dilution and divergency, but I have never been
able to see a trace of the ramifications.
If the ramifications in question are the representation of a blood-
vessel, it becomes very interesting to ascertain the cause to which
their visibility is owing. The first step in the inquiry is obviously
to determine the origin of the reddish brown light in which the phee-
nomenon is seen. It is quite clear that the brown light is no part of
the cone of refracted rays that proceed from the candle : it is equally
clear that it is not produced by two or more reflections from the
curved surfaces which bound any of the humours of the eye, because
in this case it would be of the same colour with the light of the
candle: and I have besides ascertained that it has no focus; for if
it had, it would expand and contract by any variation in the distance
* The force of this last objection will depend on the circumstances of the
case. Mr. Wheatstone says that the image ‘‘ continues only while the flame is
in motion,” and that ‘directly, or soon after, the flame becomes stationary, it
dissolves into fragments and disappears.’ Now if this is a phenomenon of ob-
lique vision, the image ought not to disappear permanently. One part of it
should disappear while another part remains visible, and the whole may for a
short time continue invisible ; but it will soon reappear, because it would require
great steadiness, both in the hand and head of the observer, to keep the shadow
on the same part of the retina, though even this would not insure its permanent
invisibility. If this, therefore, were a phenomenon of indirect vision, the difficulty
would consist in losing sight of the ramifications, whereas the difficulty really
consists in seeing them ; and this difficulty is so great with me, that I have never
been able to see them again since I saw them at Cambridge.
Scientific Intelligence. 299
of the candle. It cannot proceed from any imperfect transparency
in any of the coats or humours of the eye, because it is seen in eyes
that have the most pure and perfect vision. It must, therefore, be
light produced by.a physiological action, or light propagated from, or
induced by the direct image of the candle upon the retina; and if
this is the case, the explanation which I formerly gave of the phe-
nomenon is likely to be the true one. The blood-vessels touching
the retina will deaden, as it were, the part of the retina which they
touch, or make it less sensible to the propagated light, and hence the
blood-vessels will appear delineated in a fainter light than that which
surrounds them. The distinctness with which the ramifications will
thus be seen will vary with the intensity of the brown light, with the
ever changing sensibility of the retina, and with the varying pressure
of the blood-vessels themselves. If I could command the vision of
these ramifications as Mr. Wheatstone can, it would not be difficult
to institute experiments by which the preceding explanation could
be cross-examined; and I therefore hope that he will resume the
subject in reference to the facts and views which I have ventured to
state.
Before concluding this notice I may mention, as connected with
the subject, some curious phenomena which appear when we throw
a condensed beam of light upon the retina so as to fill the whole eye.
This may be done by holding near the eye a convex lens, about an
inch in diameter, and an inch or so in focal length, so as to see its
whole area filled with the light of a candle or lamp. If we move the
lens backwards and forwards quickly, looking steadily at one point of
the field, we shall see on each side of the axis of vision the ramifica-
tions described in my former paper and in the preceding pages.
There are none of them visible within a certain space round the axis
of vision ; but in the axis of vision there is an irregularly illuminated
or shaded circular spot, obviously corresponding to the foramen cen-
trale of the retina; and in this spot, and for some distance round it,
is seen a sort of net-work pattern, delineated in dark lines. This
pattern* has sometimes all the regularity of one formed geometrically,
with dark spots in the centre of each area, and the ground on which
the pattern is seen is generally of a faint purple colour. But, what
is more remarkable, the luminous field is crossed by exceedingly faint
bands of red and green light perpendicular to the direction of the
motion.
When the eye has not been fatigued by light, the luminous
ground on which these phenomena are seen has a minutely granular
appearance ; and by the continued action of the light an apparent
effervescence appears over the whole, as if each grain of light, or the
minute spaces between the grains, were becoming more or less lumi-
nous in succession.—Lond. and Ed. Philosoph. Mag. and Jour. of
Science, Feb. 1834.
* The very same phenomenon is seen, though less distinctly, when we look
steadily at the moving or flaring summit of the flame of a candle.
300 Scientific £ntelligence.
PATHOLOGY AND THERAPEUTICS.
Encephalic Bruit de Soufflet in Compression, or Engorgement
of the Organs contained within the Cranium.—No person as yet
had the idea of applying the stethoscope to the head, and to study
the sounds which are perceived by means of that instrument on the
surface of the cranium. Dr. Fisher, of Boston, has just been en-
gaged in researches of this kind, after having discovered what he
calls an encephalic bruit de souffiet. He made known his discovery
by rather a curious memoir which he read to the Society for the Ad-
vancement of Medicine at Boston.
As yet all he knows of the encephalic bruit de soufilet he has
deduced. from six facts, three of which recovered, and three termi-
nated in death (autopsie)., Five of the patients mentioned were at-
taeked with chronic or acute hydrocephalus ; one only had symptoms
of inflammation of the brain, in consequence of a fall on the head,
without any signs of dropsy of the brain. In a word, all these patients,
who were infants, presented symptoms of compression or engorge-
ment of the cerebral organs. In all, by applying the stethoscope or
ear to any point of the surface of the cranium, according to Mr.
Fisher, a well marked bruit de soufilet could be heard; the sound
was more distinct under the anterior part of the sagittal suture than
any other part.
Encouraged by the singularity of his discovery, Dr. Fisher ste-
thescopised the heads of several individuals of all ages, and the result
of his researches is, that the encephalic bruit de souflet does not
exist in the normal state; that by auscultation of the head the sound
of the air penetrating the nasal fosse, the sound produced by de-
glutition and that of the voice, and also the sounds of the heart,
may be easily perceived; that the encephalic bruit de souffiet ex-
ists in children when teething, but only in those who suffer much
from dentition. What is worthy of remark is that that practitioner
has observed the encephalic bruit de soufilet in two children at-
tacked with hooping-cough, but only atthe moment when the fit of
coughing ceased, and whilst the accumulation of blood towards the
head became evident from the redness of the face.
According to Dr. Fisher, that sound is produced in the trunks
of the arteries of the cranium, while they are compressed by the
brain, which takes place when that organ is pressed by fluid, or
augmented in volume in consequence of inflammation. The calibre
of these arteries is then diminished, the blood circulates with difi-
culty, and it is that impediment to the circulation, that friction of
the blood against the parietes of the arteries, which produces the
encephalic bruit de soufilet.
Dr. Fisher intends continuing his researches, and to use all his
endeavours to appreciate the real value of that symptom in pathology,
and what application may be made of it in the diagnosis of diseases
of the brain. —Archiv. Gen. Jan. 1834.
Scientific Intelligence. 301
Snow Blindness. —When. the division. Cordova marched from
Cuzco to Puno, it halted at Santa Rosa. During the night there
was a heavy fall of snow. They continued their march the next
morning. The effects of the rays of the sun, reflected from the
snow upon the eyes, produces a disease which the Peruvians call
surumpt. It occasions blindness, accompanied by excruciating
tortures. A pimple forms on the eye-ball, and causes an itching
pricking pain, as though needles were continually piercing it. The
temporary loss of sight is occasioned by. the impossibility of: open-
ing the eye-lids for a single moment, the smallest ray of light being
absolutely insupportable. The only relief is a poultice of snow,
but as that melts away the intolerable tortures return. With the ex-
ception of twenty men and the guides, who knew how to guard
against the calamity, the whole division were struck blind with the
surumpt, three leagues distant from the nearest human habitation.
The guides galloped on to a village in advance, and brought out a
hundred Indians ‘to assist in leading the men. Many of the suf-
ferers, maddened by pain, had strayed away from the column, and
perished before the return of the guides, who, together with the In-
dians, took charge of long files of the poor sightless soldiers, clinging
to each other with agonized and desperate grasp. During their
dreary march by a rugged mountain path, several fell down preci-
pices, and were never heard of more. Miller himself suffered only
fifteen hours from the surumpz, but the complaint usually continues
two days. Out of three thousand men, Cordova lost above a hun-
dred. The regiment most affected was the voltigeros (formerly Nu-
mancia), which had marched from Caracas, a distance of upwards of
two thousand leagues.—Memozrs of General Miller.
Experiments on Cicuta and Henbane, by Professor Geiger
of Heidelberg.—In the course of the chemical experiments recently
made, the author has arrived at some very interesting results on the
active principles of these two plants. The base of the poisonous
principle of cicuta is an organic salt, which appears to commence a
new: series of these organic substances so interesting to know ; in fact,
this salt is volatile, and resembles an essential oil. The singular pro-
perties of this body, whether in its natural state or combined with
acids, the rapid changes which it is capable of undergoing, and the
brilliant colours which it presents when undergoing these changes,
render it one of the most curious productions of organic chemistry.
its poisonous properties are most active, the least quantity taken in-
ternally produces paralysis; and one or two grains are sufficient to
destroy the largest animal.
Another discovery of M. Geiger is, that of the active principle of
hyoscyamus: this also is an organic salt, but fixed and capable of
crystallizing. It forms crystallizable salts with acids, and has a dis-
agreeable odour. Though not volatile, its poisonous properties are
nearly as deleterious as that of the substance just now described, but
302 Scientific Intelligence.
its effects are not similar, nor so rapid. Some animals to which: the
author administered this substance, even in a very minute dose, be-
came languid, could not support themselves on their paws, were
seized with convulsive movements, and died in the course of six
hours. The property possessed by this substance of dilating the pu-
pil is very remarkable ; the smallest quantity applied to the eye of a
cat produces a dilatation of the pupil for the twenty-four hours fol-
lowing, and the hundredth part of a grain prolongs this effect during
seven or eight days.— Reps patent Invent., March, 1833, and Ame-
rican Journal Med. Scien., May, 1832.
Treatment of Porrigo (Tinea), by M. Cazenave.—Monsieur
Biett has sometimes employed with advantage, the following lotion,
called Barlow’s lotion :
Rk. Sulphate of Potash, two drachms (gros.)
White Soap, two drachms and a half.
Lime Water, seven ounces.
Rectified Spirit, q. q. drachm. ™-
The ointments with calomel, with oxide of manganese, in the pro-
ortion of one to two drachms per ounce of axunge, have succeeded
well; the following also,
kk. White Soap, two drachms.
Sublimed Sulphur, two drachms.
' Axunge, one ounce. Mm.
Also that of Banger,
kK. Litharge, two ounces.
Calcined alum, one ounce and a half.
Calomel, one ounce and a half.
Axunge, two pounds. ~
Venice Turpentine, a half pound. -m. —
None of all these agents is, however, so efficacious as the iodide
of sulphur, introduced into therapeutics ten years ago, by M. Biett.
The following is the formula which M. Biett used after a great num-
ber of attempts : |
RK. Iodide of Sulphur, twenty-four to thirty-six grains.
Axunge, one ounce. i. :
M. Dauvergne employs the following solutions:
lodurated Solution.
kK. Iodine, three drachms, (gros).
Iodide of Potassium, six drachms.
Distilled Water, three ounces. M.-
Sulphurous Solution.
kK. Sulphuret of Potash, four ounces.
Distilled Water, a half pound. mm.
These solutions are to be mixed in the proportion of a drachm,
a coffee spoonful of the iodurated solution, with half an ounce of the
~
Scientific Intelligence. 303
sulphurous solution, that is nearly a table spoonful. The whole in a
tea-cup of tepid or cold water, according to circumstances,—Jour-
nal de Pharmacie et des Sciences Accessoires, Jan. 1834.
Lodine Antidote for Strychnine, §c.—M. Donné states, that
from closely observing a case wherein a woman’s life was lately
destroyed, experiments, the results of which are given by him in the
October number of the Annales d’Hygiene, have led him to ascer-
tain that tincture of iodine is the most effectual antidote for the vege-
table alcalies, such as strychnine, brucine, &c. The iodine, bromine,
and chlorine, form with these alcalies combinations, which in the
dose of one or two grains exert no action whatever on the animal
economy.—Revue Med., Feb. 1834.
On the Povsonous Effects of the Cyanuret of Potassium, admi-
nestered in the form of Enema.—Dr. Trouve, Professor at the School
of Medicine at Caen, communicated to me the following fact :
A patient affected with neuralgia of the trunk, was given three
enemas, each composed of six ounces of water, and six grains of the
cyanuret of potassium moistened, but still in mass. The first and
third were administered cold: the second was heated with the sand
bath, the bottle being kept corked. The three occasioned strong
convulsions and violent spasms of the extremities; the eyes were
fixed, and the pupils dilated. After some time the patient recovered,
and was able to sit up, which he had not done before for one year.
A fourth injection, composed like the preceding, only that the
cyanuret of potassium was in a pulp (en bourllie), and so moist, that
it adhered to the sides of the vessel, was administered to the same
patient, who experienced no pain or any unpleasant sensation.
A fifth injection, given thirty-six hours after the fourth, was pre-
. pared with the same dose of the cyanuret well dried, taken from a
vessel which had not been uncorked, and which scarcely exhaled any
odour. The patient died, about one hour after, having had the fol-
lowing symptoms: general convulsions, palpitations of the heart,
slow and difficult respiration, coldness of the extremities, dilatation of
the pupils, and the eyes fixed.
This fact establishes a marked difference between the action of
the cyanuret of potassium in a dry and humid state: the latter ap-
pears less active. Is it not probable, it may be on account of its de-
composition by moisture? The experiments of M. Pelouse militate
in favour of that opinion. Did not that chemist prove, that by ap-
plying heat to a concentrated aqueous solution of the cyanuret of po-
tassium, it was ehanged into ammonia, and formiate of potash, which
is inert? Would not similar compounds be formed by the prolonged
action of moisture on the cyanuret of potassium? However that may
be, we must take it into account to explain the difference in the ac-
tion of the quantity of water contained in the six grains of the cy-
anuret in pulp, (en bouillie), which necessarily diminished the pro-
vor. Vv. No. 14. 2R
304 Scientific Intelligence.
portion of the cyanuret of potassium which was contained. — Journal
de Chem. Med., Jan. 1834.
Apparent Death which was continued for twenty Days, by Dr.
Schmid.—A young man died in the hospital at Paderborn, who
could not be buried until three weeks after he had breathed, at least
to all appearance, his last breath. It was not till the twentieth day that
the characteristic phenomena of death became manifest. The cir-
cumstances of the case were these. This young man had beena
little time before cured of a tertian ague, when he re-entered the
hospital, presenting some signs which caused an apprehension of
phtbisis, without however presenting any well-marked symptoms of |
this disease. In other respects, no disturbance in his health. On
the day he died, his eyes were suddenly opened, and for some mi-
nutes we found an irregular beating at the pulse. Several small
wounds resulting from cauterizations, to which we then had recourse
to rouse him, suppurated the second, third, and fourth day. On the
fifth, the hands of the body were turned back; from the fifth to the
ninth day there exhaled from half the body an abundant sweat free
from odour. ‘Towards the end of the ninth day, there appeared over
a considerable part of the dorsal region serous bulle, similar to those
of pemphygus. The limbs still preserved their natural suppleness,
and on the eighteenth day, the lips still retained their red vermil-
lion colour. For nine days the forehead continued furrowed with
vertical wrinkles, and all this time the countenance preserved an ex-
pression never presented by the face of a dead body. The body was
kept for nineteen days in a warm room ; it exhaled not the least fetid
odour, and there was observed on no part of its surface any cadaveric
lividity. The emaciation was not very considerable, a circumstance,
which if it had existed, might have served to explain these different
phenomena.—Hufeland, Journal der pract. Heilkunde, Mai, 1833.
Archiv. Gen., Jan., 1834.
SURGERY.
Lacerated Perineum, Treatment of by Operation.—By far the
most common cause of division of the perineum in females is, the
injury sustained during a difficult labour; and this injury may pro-
ceed either from the excessive distention of the part, when the head
of the child is making its escape, or from the mal-application of an
obstetrical instrument, as of the forceps, lever, &c. Occasionally in-
deed this accident has arisen from an outward wound, or from a spon-
taneous and gangrenous ulceration ; and in addition to these causes we
may also mention, that a most complete destruction of the perineum has
sometimes followed. injudicious attempts to cure a fistula of the part.
The extent of this injury may be very different; the perineum only
may be lacerated; and this laceration may be either complete or par
Scientific Intelligence. 305
tial, the anus and its sphincter remaining entire; or a central perfo-
ration may have taken place in the perineum, and we know that in
some rare cases, the child has actually been forced through this per-
foration. In another set of cases, we find that the perineum escapes,
and the recto-vaginal septum is lacerated, or destroyed; and lastly,
both parts may be injured together. It might very naturally be sup-
posed that, when the anterior part only of the perineum, or as it is
called, the fourchette, is divided more or less, the accident would be
much more easily remediable, than when the sphincter ani is in-
volved; but the very reverse is often found to be true; for indeed,
_the re-union effected by nature in the first case is always incomplete,
and the female is constantly annoyed, more especially if she be young,
with a state of parts, in which the vulva is considerably prolonged
backwards, and has lost much of its contractility.
At present our attention will be limited to the most severe acci-
dent of all; that in which the whole extent of the perineum has been
lacerated, either with or without an injury of the recto-vaginal
septum.
This accident seems to be irremediable by unassisted nature ; the
edges indeed of the wound may cicatrize, but the healing is never
accomplished throughout its whole depth. It forms a very frightful
calamity ; the vagina and rectum are laid into one, and the discharges
of the latter are often voided by the former passage. It is however
by no means unfrequent, that the female becomes again pregnant,
and her accouchement may be the more easy and rapid.
M. Roux knows an English lady who suffered a complete lacera-
tion of the perineum in her first labour, and afterwards gave birth to
twelve children successively, the accident remaining unrelieved all
the time. He thinks it very probable that a great many females
may be the subjects of this disgusting calamity, who are ashamed to
avow its existence.
In the worst cases the state of the patient is truly miserable ; the
power of retaining the faeces, &c. may be utterly lost, and she is
sometimes constantly harassed with the desire of evacuation, and be-
fore she has time to prepare for it, the vagina and adjacent parts may
be in a moment deluged with it. She is thus forced to seclude her-
self from all society, and it cannot be surprising that her general
health soon languishes and decays.
How gratifying must it be to a feeling surgeon to be able to res-
cue a fellow being from such distress! The earliest case on record,
where an attempt was made by the surgeon to repair the loss of the
perineum, is one which occurred to Guillemeau, the disciple of Am-
brose Paré; the interrupted suture was employed, and the operation
was quite successful. Subsequently to his time, the operation, al-
though spoken of and recommended by some writers, was seldom or
never attempted, until about the close of last century; when two
French surgeons, MM. Noel and Saucerotte, performed it with com-
plete success, by means of the twisted suture. Since that period it
has been put in practice about half a dozen times in France; but in
306 Scientific Intelligence.
mos of the cases, with little or no benefit to the patients. The Eng-
lish surgeons seem to have altogether neglected making any attempt
in this field of surgery ; and the Germans, though of late they have
been ample in their descriptions of the best method of operating,
have not contributed any essential improvements. M. Dieffenbach,
of Berlin, has been most zealous in the cause; but with some of his
opinions we cannot agree; he tells us that there is no chance of our
being able to effect a complete union of a divided perineum, unless
we previously make two parallel incisions along the sides of the vulva
and perineum, in order that the parts may yield, and thus allow
themselves to be kept in easy and natural contact. We shall see
hereafter that this preliminary step is quite unnecessary, and ought,
therefore, to be altogether abandoned.
It was the following very interesting case which suggested to M.
Roux, that improvement in the operation, from which he anticipates
the most agreeable results in future.
Casre J. A young lady, twenty-two years of age, came from
Normandy to Paris in December, 1831, for the purpose of having
M. Roux’s advice respecting a division of the perineum.
She had been married to a medical man, when she was only
nineteen years old; and very soon after marriage had become preg-
nant, so that her accouchement came on just as she reached her
twentieth year. The labour was a painful and protracted one, and
required the use of the forceps for its completion ; unfortunately the
perineum throughout its whole extent was lacerated, and the recto-
vaginal septum, for about half an inch, was also torn. ‘[his dis-
tressing accident was now of two years’ standing; and nature had
done nothing to repair the injury. M. Roux, on examining the
parts, found that the division was exactly in the median linet the
perineum ; its edges or lips were quite smooth, soft, and free from
any callosities ; so much so indeed, that a person might have sup-
posed at first sight that it was a congenital defect. The anus and
vulva formed but one common outlet; and hence the condition of this
interesting patient was most loathsome and afflicting. In order that
the frequent desire of voiding the intestinal discharges might be les-
sened, she had long accustomed herself to take different preparations
of opium ; and the effect of these had been, at least in one respect,
most soothing; for by regulating the doses she could retain the
bowels in a constipated state, for almost any length of time; but not-
withstanding this relief, the patient was so afraid of the desire ever’
coming on unexpectedly, that she quite secluded herself from all so-
ciety, and her life was spent in wasting melancholy. Fortunately
her constitution was decidedly good, and the circumstance of her
having acquired the power of confining the bowels, for almost any period
which might be desired, was favourable to the success of any opera-
tion. The operation was performed in January, 1832, and as M.
Roux had at this time no experience in such cases, he followed the
practice which he knew had been recommended by most surgeons.
The suture which he employed was the twisted one. After paring
Scientific Intelligence. 307
very carefully the edges of the cicatrized lips of the fissure, he trans-
fixed them with four long needles, introducing these at least one
inch from the edges of the wound, so as to prevent the risk of their
being loosened by ulceration. No lateral incisions were made, be-
cause the part did not appear to be much stretched.
There was not an unfavourable symptom after the operation; the
urine was drawn off by the catheter-—the most strict regimen was en -
forced, and the bowels did not act. On the seventh day, M. Roux
determined to remove the needles, as the appearance of the wound in-
dicated a re-union throughout its whole extent; but, most unfortu-
nately, this appearance was fallacious, and the adhesion was nothing:
but a simple agglutination. Two days after the removal of the needles,
the wound was quite disunited, aud the part, in the course of a short
time, was in the same condition as it had been before the ope-
ration,
A second attempt was resolved upon, and the patient, although
naturaily enough disheartened by the failure of the first, was too
anxious to submit to any rational experiment, which promised a
chance of relieving her from her miserable state.
M. Roux, from reflecting upon the first operation, was inclined to
attribute its failure to the employment of the twisted suture, which,
acting almost solely on the outer edges of the wound, did not keep
up an accurate contact of the parts more deeply seated. That a
union did not take place, therefore, no one need be surprised, espe-
cially when it is considered that the parts were continually kept
moistened with the vaginal discharges.
The preliminary steps of the second operation were quite the
same as those in the first. Four strong double ligatures were passed
through the lips of the wound by means of curved needles, introduced
on the one side from without inwards, and on the other from within
outwards ; and two pieces of bougie were then laid along the two
edges, and accurately retained in their position, the one being re-
ceived into the loops of the ligatures, while their loose ends were tied
firmly over the other. Those who have employed the quilled suture,
know that a wound always gapes somewhat after its application, and
for a very obvious reason—because the pressure is exerted chiefly on
the deeper part, and very partially on the outer edges. M. Roux,
having calculated on this, took the precaution of inserting a single
fine silk ligature along with each double one; and, when he had ad-
justed the quilled suture, he then tied these single ligatures as after
ordinary operations. On the seventh day, the pieces of bougie, and,
at the same time, all the ligatures were withdrawn, and the agree-
able discovery was made, that a firm and solid union had taken place.
Every day successively, for ten or twelve days, the consolidation of
the part became stronger and more secure, and the bowels, most for-
tunately, were not once disturbed until the twenty-second day after
the operation; and, although the evacuation then was copious, and
of a hard consistence, and accompanied with so much pain and fore-
ing down, that it was necessary to assist its expulsion by pressure of
308 Scientific Intelligence.
the finger within the vagina, the re-union of the parts had by this
time become so complete, that no injury whatever was sustained.
[It would certainly have been prudent to have obviated such a
state of things by emollient enemata.—Rev. |
At the period when this patient left Paris, there was still a small
aperture of communication between the rectum and vagina, imme-
diately above the sphincter ani; the faeces did not, however, pass
through it, and M. Roux was informed afterwards that it quite healed
up.
The result of the preceding case has been most gratifying; for it
appears that the patient was speedily restored to the enjoyment of
connubial intercourse, and within five months after the operation be-
came pregnant, and was, in due time, delivered safely of a full grown
child, the perineum escaping entire and uninjured.
Case II.—A girl, twenty-one years of age, was admitted into_the
Hospital de la Charité in March, 1833. She had become a mother
nearly two years before, and so severe had been the delivery, that
the perineum had been torn completely through.
Before undertaking any operation, M. Roux subjected her to a
very spare diet for several days, in order that there might be little
occasion for relief of the bowels. The steps of the operation were
the same as we have described in the former case, and a similar
after-treatment was rigidly followed. But, as it could scarcely be
expected that the bowels would be quite so accommodating, in the
present instance, as not to act until two or three weeks elapsed, and
until the union might, therefore, be solidified, M. Roux, on the
evening of the sixth day, ordered an emollient enema to empty the
the gut. On the following morning, the ligatures and bougies were
removed, and it was found that a very satisfactory union had taken
place. ,By the end of the third week, the adhesion was perfect
throughout, except at the deepest part of the recto-vaginal septum,
where a small fistula remained, and gave exit occasionally to intes-
tinal gas; but this also gradually contracted, and had become quite
minute, when the girl left the hospital.
The third case occurred in a woman, twenty-nine years of age,
mother of five children; her last accouchement had been lingering and
severe, and the application of the forceps had induced a complete la-
ceration of the perineum. M. Jacobson, of Copenhagen, and many of
the most eminent surgeons in Paris, were present at the operation
performed by M. Roux on this woman, and they had afterwards
an opportunity of ascertaining the admirable cure that was effected.
The last successful operation was performed on a lady of rank,
mother of three children, who had suffered from this distressing ca-
lamity for upwards of two years, but who had never mentioned its
occurrence to any one, except her accoucheur, until she consulted
M. Roux. The steps of the operation were quite the same as he
had followed in the other three cases, and a most complete success
rewarded his attempt.
The only instance in which he has failed occurred very recently;
Scientific Intelligence. 309
the patient died on the tenth day. The. particulars of the case are
worth recording. :
The woman was forty years of age, and, in her, the destruction
of the perineum had been the result, not of a difficult labour, but of
an attempt which had been made by a surgeon to cure a fistula ani,
communicating with the vagina. In consequence of this, the parts
must necessarily have been more or less diseased, and, moreover, the
patient laboured at the time under a complete prolapsus of the rec-
tum: whenever she stood erect, or coughed, sneezed, or in any way
exerted herself, the inverted gut was forced through the large gap
in the perineum, forming a tumour as big as a man’s fist; it might,
indeed, be returned, but no means that had been used could keep it
up permanently. When this patient entered the Hopital de la
Charité, she was suffering from continued fever, accompanied. with
diarrhoea, distress of the abdomen, and other symptoms, which indi-
cated some inflammatory disorder of the mucous surface of the bow-
els. During a period of four weeks, an appropriate treatment quite
recovered her; and then, at her own earnest request, M. Roux pro-
ceeded to the operation. Unfortunately, on the third day afterwards,
fever again set in, the abdomen became very tender, and the diarrhcea
returned. The wound did not exhibit any appearances of the adhe-
sive process, and the ligatures had caused ulceration. On the seventh
day, the bougies and threads were removed, and, on the ninth, the
disunion was complete; on the following day she died. It is quite
reasonable to suppose, that the irritation of the ligatures reproduced
those symptoms of intestinal disturbance which ultimately proved
fatal; and M. Roux is candid enough to avow, that perhaps he did
not delay the operation for a sufficient length of time after the first
illness.
In conclusion, M. R. offers some remarks as to the proper period
after the occurrence of the accident for the performance of the ope-
ration. When it has taken place during parturition, (and this is by
far the most frequent cause,) it would not be judicious to attempt by
art the union of the laceration for at least two or three months ;. the
highly nervous and impressionable state of constitution in a parturient
woman, the recent extreme distention of the parts, the copious flow
of lochia, &c. are potent reasons against an early operation. Let the
wound, therefore, be left to Nature’s efforts, until these objections no
longer exist, and let the medical man be satisfied with the gentlest
treatment.
It will be found that, in most cases in which the operation is
performed, a very considerable degree of dysuria takes place for some
days; the catheter ought, therefore, to be carefully introduced twice,
or oftener, a day... In every one of M. Roux’s successful examples,
the lips of the wound close to the anus, or recto-vaginal septum, were
found to be disunited, although the rest had healed at the time when
the ligatures and bougies were removed. There always remained
for a week or more, at this part, a fissure, not unlike that which we
make in operating for fistula ani; this fissure gradually, however,
310 Scientific Intelligence.
contracted, and the anus, into which a small oiled tent should be in-
troduced, quickly recovered its healthy condition. The part of the
wound most slow in healing is the recto-vaginal septum, and the pro-
gress, in some cases, will be found very tedious, in consequence of
the extreme difficulty in preventing the passage of the faces, or of
the intestinal gases, from the gut into the vagina. But even this, in
course of time, and with the assistance of the judicious surgeon, will
contract more and more until it finally closes entirely.
The success which M. Roux has obtained, in a set of cases which
are by no means unfrequent, and which, hitherto, have too often
baffled surgical relief, encourages him to hope, that the operation
which he has recommended will become as common, and as fortunate,
as that of staphyloraphy, which he was the first to perform in 1819,
although, since that time, no fewer than sixty-five cases have pre-
sented themselves to his notice.—Med.-Chir. Review, and Jour. of
Prac, Med., edited by Dr. Johnson, April, 1834.
Hearing, through the Apertures made by the Trephine.— While
watching the effects of the operation of trephining, in several pa-
tients at the Hotel des Invalids, M. Perier, an assistant surgeon, has
discovered, or at least has imagined that he discovered, that they
were all conscious of a sensation of a very unusual and constant
noise in the part. We have seen the following experiments made at
the clinique of the Baron Larrey, and in the presence of the philo-
sopher, M. Savart. The ears of a patient, on whom the operation
had been performed, having been well stopped, while the rest of the
head was left unincumbered and free, it was found that the sense of
hearing was not at all affected, but that he could still perceive every
sound quite distinctly, and the more so, when the sounds were di-
rected perpendicularly downwards on the surface of the cicatrix.
Even at a considerable distance sounds could be satisfactorily enough
distinguished to enable the person to hold conversation with another.
The beats of a watch held at a short distance from the cicatrix, were
also made out.
Now if, while performing any of these experiments, the artificial
aperture in the skull was well covered and compressed with the hand,
while the ears remained plugged, the perception of sounds was imme-
diately obstructed.—Jbzd.
Purification of Theatres of Dissection, §&c.—A special com-
mission was lately appointed for the purpose of ascertaining the best
method of disinfecting anatomical’ theatres of their stench and un-
wholesome effluvia. They tried a multitude of expedients, but found
that the use of simple charcoal powder was much the most effica-
cious. Some of this powder was blended with and sprinkled over
the putrid contents of the bowels one day, and on the next, it was
always found that their offensiveness was in a great measure re-
moved; and if the students rubbed their hands’ well with the char-
coal before they washed them, all unpleasant smell was most cer
Scientific Intelligence. 311
tainly got rid of. This practice has been tried extensively at the
dissecting amphitheatre of the La Pitié Hospital, and from its sim-
plicity and efficacy is now constantly adopted there.
One great advantage of the charcoal is that it is a harmless sub-
stance, and that it does not even cause the steel instruments to rust,
which unfortunately is apt to be the case, if the preparations of
chlorine are used as a disinfecting agent.— Ibid.
Traumatic Tetanus.—A midshipman, on board of an Indiaman,
got wounded in the left foot by treading on arusty nail, 14th August.
He kept his watch during a cold, rainy night, and, by eight o’clock
next morning, presented symptoms of trismus. An opiate with
camphor was exhibited, but the tetanus increased, and the limb was
cold, and as he described it, dead and powerless. The pulse was
120, and his situation altogether alarming. It was proposed to the
surgeon of the ship, by Dr. Murray, the narrator, to tie the posterior
tibial nerve, and thus cut off communication with the wound. This
was done, and although almost incapable of articulating a word the
moment before, he immediately opened his mouth with an exclama-
tion, His countenance presented a remarkable change for the better,
and he said he felt life returning to his lee. The original wound
was dilated, and a poultice applied. His bowels were now copiously
opened, after which he fell into a sound sleep, which continued four
hours. The tetanic symptoms, however, though mitigated, did not
disappear, and it was deemed advisable to bleed the patient to syn-
cope, two days afterwards. By the 18th of August, the tetanic
symptoms had nearly disappeared, and he convalesced rapidly from
this time. This case is related by Dr. Murray in the sixth volume
of the Calcutta Medical and Physical Transactions.—Jbid.
Neuralgee Affections of Stumps.—The following case occurred
in St. Bartholomew’s Hospital, and is published in the Medical Ga-
zette, No. 325, by Mr. Crookes, the house-surgeon.
‘* Sarah Slyfield, about eighteen years of age, was admitted into St.
Bartholomew’s in July last. She had undergone amputation of the
right thigh in the country about nine months before her admission,
for disease in the knee-joint, the effect of an injury received several
years previously. When received into the hospital, she stated that
the pain in the stamp had come on within a few days of the removal
of the limb; and that, although the part had been carefully exa-
mined, and means adopted for her relief, it had continued to increase,
almost. without intermission, up to the present time. Shortly after
' the wound had healed, six months after the operation, a small lump
formed in the extremity of the stump, which was opened, and se-
veral pieces of dead bone extracted, but without affording any relief..
Menstruation had commenced about the age of sixteen, and conti-
nued regularly up to the period of the operation, but has since only
occurred once. Her person was stout, with a hale and somewhat
bloated countenance, and she complained of nothing but severe and
VOL. Vv. NO. 14. 2s
312 Scientific Intelligence.
incessant pain in the stump. Examination of the part much in-
creased her distress, as the slightest touch in any point of its integu-
ment gave her pain. The limb was naturally large from fat, but
without any swelling or redness; and the extremity of the bone
seemed well covered by soft parts. She was bled to sixteen ounces,
and ordered purgative and saline diaphoretic medicines, and to apply
linseed meal poultices.
‘‘ This painful affection, which was so severe as almost entirely
to prevent the patient getting rest, continued gradually to increase
for about four months, in spite of the adoption of the most active re-
medies. Local and general bleeding, counter-irritation by moxa,
narcotics, and the application of sedative plasters to the stump, with
tonics and antispasmodics, were all tried in vain; and the patient
began to entreat to have the stump removed, to procure her, if pos-
sible, some alleviation of her sufferings. During this time she also
experienced repeated attacks of hysteria; and was once seized with
pain and acute sensibility of the integuments of the abdomen, which
at first excited a suspicion of peritonitis.
‘« As it was suggested by some that there might be suppuration
in the extremity of the stump, a puncture was made into it, and the
knife carried to a considerable depth, but without evacuating any
matter, or producing any beneficial effect: it was therefore resolved
to perform a second amputation of the limb.
‘“ Oneration.—On account of the shortness of the stump it was
impracticable to employ the tourniquet, and compression was made
on the artery, as it passes beneath Poupart’s ligament, by an instru-
ment ordinarily used for that purpose. The muscles on the outer
part of the thigh were first divided, and those on the inner, including
the artery, last, in order that the vessel might be secured as soon as
cut through. The bone being sawn through, and several small ves-
sels tied, the ischiatic nerve was drawn out, and about an inch of it
removed ; some of the branches of the crural nerve were also cut
shorter. Fifty minims of laudanum were given after she was taken
to bed, as she was suffering great pain.
‘* Examination of the Stump.—The. extremity of the ischiatie
nerve was bulbous, and of an almost cartilaginous hardness, and from
this bulb there was continued in various directions a layer of dense
cellular tissue, connecting it with the bone, the muscles, and the ci-
catrix. One of the filaments of the anterior crural nerve, perhaps
the nervus saphenus, had also a bulbous termination, comparatively
much larger than the ischiatic, and was similarly connected with the
surrounding parts. The extremity of.the bone appeared free from
disease, nor was there any suppuration in its neighbourhood.
‘‘ From the time of the operation up to the period of her dis-
charge from the hospital, with the exception of a slight recurrence of
the painful sensibility of the integuments.of the abdomen, she con-
tinued to go on well, never having experienced any pain in. the
stump, or any unfavourable symptom.. The remaining portion of the
limb was very short, but sufficient to permit of the adaptation of the
Scientific Intelligence. 313
ordinary wooden leg, with the additional security of a strap to pass
over the shoulder.’—Jbid.
On the Branchial or Gill-like Openings in the Neck of the Hu-
man Foetus, as a Cause of certain Malformations.—M. Ascherson,
the author of this memoir, lately published in Latin at Berlin, has called
the attention of his medical brethren to a curious congenital anomaly,
or ‘“‘ vitiam formationis,” which he has observed in several persons.
The number of cases altogether amounts to eleven ; and most of them
occurred in female children, of a scrofulous, or at least of a lymphatic
constitution. The authenticity of most is guaranteed by the testimony
of that able physiologist Rudolphi. The following may be given as a
brief description of the disease: On the anterior and lateral part of
the neck there is observed a fistulous opening, which is situated ge-
nerally in that triangular hollow between the clavicle and the two
points of insertion of the sternomastoideus ; but sometimes it is at
the inner edge of this muscle. It is much more frequently found on
the right than on the left side; and if there should happen to be
one on either side, that on the right is always larger and placed
somewhat higher up than the other one. The aperture is invariably
very narrow; occasionally scarcely visible, but at other times it is
surrounded with a red cirele, or it may project like a papilla. It
generally follows the movements of the pharynx in deglutition, and
when this is the case, we observe a transverse furrow, at the bottom
of which is situated the fistulous opening. If a probe be introduced, it
may perhaps be pushed forwards a little way, but in most of the cases
it is stopped very soon, in consequence of the sinuosity of the canal.
In one case, fluid, injected at the outer opening, passed into the
pharynx, and the patient was sensible of its taste; and in another,
the attempts made to cure the fistula in this way were followed by
disagreeable consequences, such as swelling of the neck, smarting
pain, and the sensation as if a foreign body was sticking in the pha-
rynx. On no occasion was any air ever observed to escape from the
opening, even when the effort of expiration was strong, while the
mouth and nostrils were kept closed. The discharge from the fistula
was sometimes viscid and clear, and at other times, more of a puru-
lent appearance; and it was remarked that in the latter case the
quantity of the discharge was always more profuse. Although
this disease be congenital, it may increase after birth beyond its
original extent. Eight of the cases seen by Dr. Ascherson, occurred
in females, and three in males. These fistule now. described have
some analogy with the tracheal fistulae recently discovered and ex-
plained by M. Dzondi; but the origin and the anatomical characters
of the two are very different. In order that we may compare them,
we have extracted the following remarks from Dzondi’s narrative.
‘“‘ At the anterior part of the neck, about the middle of the con-
cave edge of the thyroid cartilage, there is found a small round
opening, of about a line in diameter ; its edges are neither red, tume-
fied, nor surrounded with any fleshy rim. It is not painful on being
314 Scientific Intelligence.
toucked ; and when firmly compressed, several drops of a puriform
fluid may be made to flow out. A probe cannot be pushed very
deep, in consequence of the winding track of the fistula, and on no
occasion can it be introduced into the trachea, although a few bub-
bles of air almost always escape upon any forcible expiration.”
These tracheal fistule may be associated, or occur in connexion
with other congenital anomalies or irregularities of formation ; espe-
cially with those which are denominated ‘ monstrosities from asym-
physis,” that is, from an incomplete junction of the two lateral
halves of the body. We cannot, however, take the same view of
those described by M. Ascherson, because they are not situated in
the median line of the body; and as they have no communication
with the air-passages, we must necessarily infer that their origin is
not similar. He is of opinion that they should be regarded as pro-
ceeding from some anomaly,or aberration of the nisus formativus,
congeneral with those which cause an arrest of the development of
the foetus, during one of those phases which it successively passes
through, before it reaches its perfect state. To one of these transi-
tion forms belong the branchial fistulee discovered by Rathke, first in
the young of the pig, horse, hen, water-snake, (coluber natrix,) and
lizard, and afterwards in a human embryo, about seven or eight
weeks old. These fistulee or tubes consist in from six to eight aper-
tures, arranged symmetrically on either side of the neck, opening
into the pharynx, covered externally with a sort of operculum, and
exhibiting on their inner surface several arched lamella. Rathke
compares these apertures with the branchial apertures of the shark ;
and a beautiful confirmation of this opinion may be derived from the
identity which exists in the vascular arrangements of fishes and of
the early chick, as clearly made out and described by M. Huschke
of Dresden. This anatomist publicly demonstrated that the aorta of
the young chick gives off six branches, which pass on to the inner
surface of the branchial arches, (or those lamellae which are con-
sidered as rudimentary branchie,) and which afterwards communi-
cate with, and terminate in, the descending aorta. Baer has veri-
fied the existence of these branchial apertures in the fcetal dog and
rabbit ; and his observations have been confirmed by Burdach,
Muller, Allan Thompsom, and Becker. M. Rudolphi mentions hav-
ing seen at Stralsund, an infant, in whom the closing up of a fistula
of this sort, brought on aphonia, epileptic convulsions, and other |
alarming symptoms, which gave way only when the ulcer was re-
established, and the discharge permitted to flow. In one of the
cases related by Dzondi, the healing of the fistulous opening was
followed by a train of evils which finally proved fatal.—Jdid.
Section of the Tendo Achillis, as a Means of Cure for Club-
foot (pied bot), by Dr. L. Stromeyer, Professor of Surgery, &c.
Translated from the German, by Dr. G. Richelet.—The section of
tendons for the cure of certain deformities, had already been pro-
posed; but to Delpech belongs the honour of having raised it from
Scientijic Intelligence. 315
oblivion, and submitted it to rules. According to him the tendon to
be divided should not be exposed; the section ought not to be made
by an incision parallel to that in the skin, for it might cause the
sloughing of the tendon. Immediately after the division of the ten-
don, the two ends ought to be brought into contact, and maintained
by a convenient apparatus, until they become consolidated; that re-
union taking place by the interposition of a fibrous substance of new
formation, you must, before that substance has obtained all its soli-
dity, elongate it by means of extension gradually augmented ; lastly,
when it is sufficiently elongated, the part must be maintained in its
situation, until the intermediate substance has acquired all its so-
lidity.
Such are the principles on which the operator ought to act.
However, the surgeon of Montpellier does not seem to have com-
pletely fulfilled the indications laid down by himself. In the case
described in his work, he divided the tendo achillis, in a young man,
aged nine years, in the following manner: the patient being laid on
his face, a bistoury was passed behind the tendo achillis, so that on
each side of the tendon a wound of about an inch in length was left.
The instrument was immediately withdrawn, and a convex knife was
introduced, with the cutting edge towards the tendon, by which
means it was divided transversely from behind, without dividing the
integuments situated immediately above. But by that operation the
exfoliation of the tendon was not prevented. The sides of the ten-
don became adherent to the bottom of the cicatrices, which had formed
slowly in consequence of the suppuration, the movements and flexion
of the foot gave rise to a disturbance of the skin: besides which it
gave great pain. | .
Dr. Stromeyer has modified in the most ingenious manner the
operation of Delpech, and has experienced remarkable success, which
may be seen in the two following cases: |
Cast I.—Georges Ehlers, aged nineteen, was attacked in his
fourth year, without any known cause with a deformity of the left
foot, which had progressively augmented. The therapeutic means,
and the apparatuses at first employed produced a little amelioration,
but afterwards the disease made such progress, that walking became
quite impossible. The excoriations, and deep suppuration which
followed these attempts at reduction, brought on caries of the fifth
metatarsal bone, the cure of which was delayed for several years.
The parents then renounced all treatment, and had made for their
son, who was at this time fourteen years of age, a wooden leg which
had its resting point on the sciatic tuberosity, and which was fixed
to the leg by straps and buckles. With this apparatus he could walk
tolerably, although slowly, leaning on a stick in dry, and on a crutch
in wet weather.
When he consulted Dr. Stromeyer, in October, 1830, he pre-
sented on the left side a club-foot, (pied bot). The nails were
strongly turned inwards and downwards; the external side of the
foot was entirely under the axis of the leg, and all the foot was in
S16 Scientific Intelligence.
such a state of extension, in consequence of the contraction of thie
gastrocnemii muscles, that the sides of the foot formed a straight line
with the anterior surface of the leg. Above the external border of
the foot, the traces of two callosities existed, which were formed
during the time the patient rested on that part while walking at the
commencement of the disease. On the fifth metatarsal bone was a
cicatrix of about an inch long, adhering to the bone. The mobility
of the foot was very limited: the leg much emaciated. The calf,
which was drawn up into the bend of the leg, was scarcely percepti-
ble, unless the muscles which constituted it were put into action by
the movements of the leg. The continued use, during five years, of
the wooden leg had determined, in the articulation of the knee, a
considerable deviation outwards. The right leg was very muscular ;
but the right foot presented a considerable dorsal convexity, which
made it appear shortened, and resembling a horse foot, ( pied équan) ;
that form had no unpleasant influence on its function. The author
cites that last phenomenon, because it proves, according to him, that
the cause of the deformed foot is situated in the spinal marrow.
The mobility which still existed in the articulation of the foot,
and the firm resolution of the patient, determined Dr. Stromeyer to
make some new attempts. The use of the extending apparatus
effected, at the end of three months, only the development of the sole
of the foot, and an amelioration in the position ofitssides. Whena
greater force was used, there resulted excoriations in the sole of the
foot, which were difficult to heal. It was then they determined on
the division of the tendo achillis, as a last resource.
The operation was performed on the 28th February, 1831; the
patient being placed on a table, before the operator, with his left side
towards him, an assistant fixed the knee, another held the foot, and
flexed it so, that the tendon was strongly stretched. A sharp pointed
bistoury, very narrow, and bent so that the cutting edge was convex,
was passed in two inches above the insertion of the tendon, between
it and the tibia; the back of the bistoury being turned towards the
bone, and the cutting side towards the tendon ; which was divided by
the introduction of the instrument; the division was made with a
perceptible noise. The indication of making the external wounds as
small as possible, so as to prevent the entrance of the air, exfoliation
of the tendon and suppuration, was perfectly fulfilled, for only the
point of the instrument traversed the opposite side, without making
a bleeding wound, and the wound where it entered was only the size
of the blade. ‘Ihe division of the tendon was favoured by the ex-
tension which an assistant made by means of strong flexion of the
foot: the loss of blood was very insignificant. The retraction of the
tendon was very inconsiderable; however, by flexion of the foot,
there was a separation of three quarters of an inch between the two
ends, without the form of the foot being much ameliorated. In the
extension of the foot, that interval disappeared, and the ends of the
tendon were in contact. The two small wounds were covered with
two pieces of adhesive plaster. On each side of the tendon was
Scientific Intelligence. ol?
placed a long narrow compress, maintained by the first turns of a
bandage which encircled the foot in the figure of 8, and was des-
tined to keep it in the extended position. The employment of a
splint was not considered necessary, for the atrophy of the muscles
did not produce any fear of the displacement of the ends of the ten-
don. The limb was rested on a cushion.
The third day, the wounds were healed; the ends of the tendon
appeared a little swollen and sensible to the touch: on the internal
malleolus, there was a little ecchymosis. The movements of the foot
produced no influence on the superior portion.
The sixth day, the ecchymosis was dissipated. The ends of the
tendon were re-united, so that the moving of the foot with precau-
tion, put in motion the upper portion of the tendon. The swelling
corresponding to the re-union of the two ends was scarcely percep-
tible ; still that place was the seat of great sensibility.
The tenth day after the operation, that sensibility was in a great
measure dissipated ; the two ends were already so solid, that the pa-
tient could, by the voluntary movements of the foot, put in motion
the gastrocnemii, and stretch the tendon achillis. The touch gave
but an imperfect idea of the distance that existed between the two
ends.
Dr. Stromeyer thought the time to use extension was come, and
he applied his apparatus, the description of which is given lower
down. At this time the foot formed with the leg a very obtuse angle,
and the machine for extending was put in motion, but with the
greatest precaution, for fear of tearing the new adhesions, and of
causing pain in the seat of the cicatrix. At the end of a week the
screw could be turned more frequently, without causing pain. Eight
weeks after the operation, the foot was at right angles with the lee.
At this time the patient wore a buskin, furnished on the external
side with a plate of iron, which had a joint opposite the articulation
of the foot. At this joint was a screw, the revolution of which could
diminish the angle which the foot made with the leg, without dimi-
nishing the mobility of the joint. With this buskin the patient was
soon able to walk in his chamber, with the aid of a stick; however,
as the leg was weakened by inactivity for several years, it soon be-
came fatigued and oedematous. From that moment he took exercise
daily, first in his chamber, then in the garden, and acquired so much
strength and assurance, that, fourteen days after the first attempts,
he was enabled to walk a quarter of a league and return. At first
he wore the extending apparatus every night, and the buskin during
the day ; but as the application of that machine was painful, in con-
sequence of the oedematous state of the limb produced by walking,
he wore the buskin night and day, removing it twice a day, for the
purpose of rubbing the foot with camphorated spirits. During the
night, by means of the screw, the angle which the foot formed with
the leg was diminished. You' could not by the touch accurately dis-
tinguish the length of the intermediate substance newly formed, for
the points where it commenced could not be ascertained, and the
318 Scientific Intelligence.
tendon was felt to be narrower only opposite the section. The foot of
itself could be placed at right angles with the leg. The cedematous
swelling did not yield for two months to the use of lotions and spiri-
tuous baths. The gastrocnemii muscles increased during that period,
but they were situated much higher up than in the right leg, which
proves that the straightening of the foot was not due to the elonga-
tion of the muscles, but to the intermediate tendinous substance. The
deviation of the knee disappeared with surprising rapidity ; there
was no trace of it six months after the operation.
When Dr. Stromeyer drew up this case a year and a half had
elapsed since the operation ; the form of the foot had not ceased to
improve ; it had attained its natural situation, without any inclination
of the point inwards; the size of the limb, although less than the
opposite one, had much increased. The tendency to cedema had
entirely ceased. At the end of six months the patient did not require
the use of the buskin, furnished with a plate of iron. He walked
with a common boot without a stick, and no person could by his walk
have any suspicion of the former state of his foot, for he could put it
on the ground without any effort, with the point directed forwards,
even while walking rapidly.
A severe contusion, during the course of the preceding summer,
by the pressure of a narrow new boot, forced the patient to keep
quiet for some weeks. However, the position of the foot was in no
way altered, which proves that the intermediate substance had no
tendency to retract, and that the cure could be considered as per-
manent,
Case Il.—M. B. Blumenthal, aged thirty-two, having heard of
the favorable result of the former case, came to consult Dr. Stro-
meyer in May, 1832, fora club-foot of the left side. This disease had
its origin in convulsions, which the patient had at the age of eighteen
months; it had eradully increased, without, however, at first pre-
venting his walking, as he used to follow his occupation as cattle
dealer: but, after some time, walking became difficult, and so painful
that he was obliged to keep his bed from time to time. A hernia,
on the right side, succeeded in 1831, which forced the patient to
renounce all fatigue.
When he consulted Dr. Stromeyer, the distorted foot was nearly
in the worst state. The exterior side of the foot was so turned
downwards and inwards, and also the nails, that in walking he rested
on the front of the foot, when there was formed a thick horny col-
losity. The point of the foot, which was completely turned inwards,
in walking, irritated the skin which covered the internal malleolus of
the opposite side. The heel, which was drawn up, did not touch the
ground ; the tendo achillis was narrower than that of the sound
limb; the muscles had not lost much of their size, but they were
drawn up higher in the bend of the leg; the articulations were still
moveable, both by the will, and by a foreign impression ; however,
the movements of the foot were very limited. That mobility, the
slight atrophy of the leg, the determination of the patient, &c., de-
aD
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cided Dr. Stromeyer to attempt the operation of dividing the tendo
achillis.
Before commencing the operation, Dr. Stromeyer took off the
hardened cuticle, which covered the back and ‘side of the foot, and
which, in some places, was a quarter of an inch thick, then, having
enveloped the foot in a woollen stocking, he placed it in an extending
apparatus. He had only in view the replacing the foot in the axis
of the leg. It was only after having arrived at that, the 12th June,
1832, that he divided the tendon.
The operation was performed as in the preceding case, only that
the bistoury was introduced three inches above the insertion of the
tendon, so as to remove, as much as possible, the compression of the
apparatus from the wounds. The tendon being thicker than in the
first patient, the simple introduction of the bistoury was not sufficient
for its division, it was obliged to be passed about half an inch without
the opposite side; the division of the tendon was made with an au-
dible crack. After its division, when an attempt was made to flex
the foot, the form of which was in no way modified, the two ends of
the tendon were separated from one another nearly half an inch; by
the extension of the foot they were brought into immediate contact.
The two external wounds which were not larger than the bistoury, and
from which very little hemorrhage succeeded, were united by means of
adhesive plaster. In this patient, however, in consequence of the
development of the muscles of the leg, a strong restraining power
was placed on the anterior aspect of the foot, to prevent all voluntary
movement, A short time after the operation, and principally the
following night, the patient suffered from severe cramps in the calf
of the leg, which came on when he slept, and which forced him to
remain awake all night.
The second day, the ends of the tendon were not in contact; to
prevent any muscular contraction, a bandage was applied over the
whole lee, but this means completely failed, and this night was passed
as the preceding. This unsuccessful attempt determined Dr. Stro-
meyer to abandon the bandage, and the cramps were not renewed.
The fifth day, the wounds were cicatrized, and the two ends of
the tendon united, of which they weré assured by moving the foot.
But, to allow time for the reunion to become more solid, the extend-
ing apparatus was not used until the tenth day. Under the influence
of this apparatus, the position of the foot improved so rapidly, that at
the end of five weeks the foot formed a right angle with the lee.
The patient was then made to use the same buskin as in the former
-case: but its application was not rendered painful by any cedema.
In the commencement exercise caused pain in the seat of the cicatrix,
but it soon disappeared.
About ten weeks after the operation, at which time Dr. Stro-
meyer lost sight of the patient, the foot formed a right angle with the
leg; the sole of the foot rested horizontally on the ground in walking ;
the back of the foot was still very convex, which was manifestly owing
toa curvature of the metatarsus; when he walked with care the
VOL. vy. NO. 14. 2T
320 Scientific Intelligence.
foot was carried outwards; when he walked quickly, the point of the
foot deviated a little inwards, but not so far as to injure the opposite
side. The muscles of the calf were increased in a remarkable man-
ner, but they were still situated higher up than in the right leg. As
in the former case it was impossible to appreciate the length ef the
intermediate substance, which, however, appeared weaker than in
the former case in the situation of the section.
In these two cases, the second of which has been abridged in
consequence of its great similarity in many respects to the former,
talent and perseverance succeeded, in a very short interval of time,
in overcoming a deformity which might have been reasonably re-
garded as incurable, as much on account of its long standing, as on
many other unfavorable circumstances. The extending apparatus,
invented by Dr. Stromeyer, is composed of a splint a little longer than
the leg, and terminated below by a rounded hollow, destined for that
part of the leg which corresponds to the external wounds and that of
the tendon, as well as the projection of the heel. Between the two
sides which bound the hollowed part, a moveable piece of wood, in
the shape of a sole, is situated, and. which consequently could form
greater or less acute angles with the splint. At the lower end, the
two sides are united by akind of roller or moveable cylinder, furnished
at one extremity with a cog wheel (roue dentée,) which is turned by
means of a small lever. A cord which passes underneath the foot-
board, near its anterior third, passes up on each side, passes over two
pullies fixed laterally near the middle of the splint, reascends, and
passes round the moveable cylinder. After having enveloped the leg
in a convenient manner, and having put on a woollen stocking, it is
adapted to the splint, which corresponds to the posterior surface of
the leg, by leathern straps; the sole of the foot rests on the move-
able foot-board, which at first forms with the splint (in the case of a
club-foot) an obtuse angle above, and an acute angle below; the
foot is firmly fixed on the foot-board. Ifthe cylinder is turned, the
cord rolling more and more on it raises the foot-board, and fiexes the
foot. An iron stop, which falls between the teeth of the wheel of the
cylinder, prevents it from returning on itself. By these means a very
strong extension of the tendon may be made, and graduated at will.—-
Archiv. Gen., Jan., 1834.
Re-union of the Extremity of a Finger which was completely
cut off, by Dr. Angelo.—On the first of January, 1818, a day dur-
ing which the cold was more intense than I ever felt it in our dis-
trict, (at Chiavari), Emmanuel Copello, cut off at one blow with a
very sharp knife, the extremity of the index finger of the left hand.
The division took place transversely below the root of the nail. The
child immediately took up this portion of the phalanx which fell
on the ground, re-applied it to the wounded finger, and hastened off
to the shop of M. Podeste, an apothecary, about fifty paces distant
from the place where the accident had just occurrred, for the pur-
pose of having it dressed. There he took off the detached portion of
Scientific Lntelligence. 321
the finger to shew the cut, and re-applied it immediately. At the
end of about fifteen minutes I came to the shop. I examined the
finger carefully, and observing that the child had not replaced the
extremity of the phalanx, so as to correspond exactly with the finger,
I wished to remove it a third time; but whether the coagulable
lymph made it already adhere, or what is not very probable, whether
this adhesion was the effect of coagulation of the blood, I found the
approximation so solid, that I did not think it right again to detach
the extremity of the finger by employing force; I dressed it, how-
ever, the best way I could, and finally, kept it in its place by means
of two straps of diachylon, which I secured by two circular turns
made with a third strap. The finger was covered with some linen
soaked in balsam of Peru, and the whole enveloped in an appropriate
bandage. I recommended the patient to keep his arm ina sling, and
carefully to avoid striking his hand against any thing. The fifth day
T removed the dressing, and I saw that the skin of the extremity was’
livid. I now thought that mortification was proceeding, when on
raising the epidermis thus charged, I perceived beneath it the cutis
red, and completely re-united. I encompassed the finger with lint,
still leaving on the two straps which crossed each other at the extre-
mity of the finger. Three days after I removed the dressing entirely,
and was satisfied the re-union was complete. The mortified skin
came off like the extremity of the finger of a glove: beneath the di-
vided part of the root of the nail, we already saw the rudiments of a
new nail.
The sensibility of the extremity of this finger remained for a
considerable time more obtuse than that of the other fingers, and its
point was not as thin as before. In the point corresponding circu-
larly to the division, the cicatrix left around the finger a depressed
line similar to what would exist, if the end of the finger had been for
a long time compressed in the narrow neck of a bottle.-—Annale
Universalt di Med., Sept., 1833. Archiv. Gen. Jan., 1834.
On the Employment of Casts, (moules en platre), in the Cure
of Fractures of the Leg, by A. L. Richter.—The knowledge of this
practice, so very much used among the Arabs, was imported into
Europe by the English consul at Bassora, who inserted an observa-
tion in the Medical Commentaries, dec. ii. vol. ix. It was not till
1828 and 1829, that the practice was adopted, and with the happiest
success in the Hospital la Charité, of Berlin, according to the direc-
tions given by Dr. Kluge. At first they made use of a box large
- enough to contain the entire leg, the condyles of the femur being
contained in it. The box was filled with sand to half its height; on
the sand was placed a paste-board splint, six inches broad, and two
others were sunk perpendicularly in the sand along the two edges of
the first, so that the space included between the splints represented
exactly the form of the cast. The splints and calf of the leg were
rubbed with oil, and the foot kept in a proper position. They then
poured on rapidly some liquid plaster, which became hard at the end
322 Scientific Intelligence.
of half an hour, ‘and enveloped half the thickness of the lee; then
they removed the splints and the box. The latter was in consequence
modelled (modifié) ; it was made twenty-two inches long and seven
inches broad, with moveable sides, articulated on each other, and so
that the one might be taken.after the other from the hardened plas-
ter. Two species of cast (moule) may be distinguished: the first,
which is applicable in simple and continued fracture; the second,
which is preferred in compound fractures, is formed of separate
pieces. Then the foot can be placed in a fixed position, and the ne-
cessary dressings applied over the upper part of the leg.
Some precautions are necessary in the use of this apparatus.
Ist. It is only after the swelling has attained its maximum, that
the limb is to be surrounded with its cast, otherwise we shall content
ourselves in fixing the foot.
Qnd. The plaster should be perfectly white, prepared for some
time, and finely powdered ; without this, it developes some heat in so-
lidifying.
3rd. The plaster, mixed with water, ought to have the consistence
of cream; if it were more solid, the limb would be burned ; it is well
to try it first in the hollow of the hand.
Ath. The extension is to be continued. as far as the solidification
of the plaster. This apparatus has over all others the advantage of
keeping the fragments in the most exact manner, as well as preserving
the extension, and it frees the patient from all the pains which are the
result of unequal pressure, and from the excoriations which are its con-
sequences. The patient (particularly if the leg is on a moveable
board) avoids the annoyance of seeing his apparatus deranged, for he
feels that the limb is supported exactly on all sides. At the end of
a month the leg is gently raised, and the lowest part of the casts only
is laid aside. It is in oblique fractures with projection of the bone
under the skin, that this method renders the most essential services.
‘The two fragments cannot then slide one upon the other, and can re-
sist muscular contraction. These advantages are still more manifest
in fractures which occur near the articulations.—Eztract from a
work of Dr Richter’s. Berlin, 1832. Archives Generales, Feb.
1834.
Worms in the Blood.—History of a Case nm which Animals
were found in Blood drawn from the Veins of a Boy, with Re-
marks, by J. Stevenson Bushnan, F. L. S., Surgeon to the Dum-
fries Dispensary.—A boy, eight years of age, living on the banks of
the Nith, the waters of which he had always drank, ‘“‘ was visited.
professionally in June last, by Mr. Bushnan of Dumfries, who found
him labouring under influenza, at that time epidemic.”-—‘* He com-
plained of great headach, his pulse was full and strong, and 100 in
the minute,” The mother of the patient, when she requested Mr.
Bushnan’s advice, informed him that her son had been bled, and that
fifteen worms had been found in the blood drawn; one of which she
produced in a cup of water. The worms were stated to have been
Scientific Intelligence. 323
visible in the blood in less than a quarter of an hour after it had been
drawn.
Mr. Bushnan deemed it expedient to abstract about six ounces of
blood, in which he could discover nothing preternatural. He co-
vered it with a basin in such a way as that it could not be disturbed
without his knowledge.
In an hour afterwards he found five animals swimming in the
serum, all most vigorous and lively. On dividing the clot, the ani-
mals made powerful efforts to disengage themselves from it. Hight
were disengaged, making with the five discovered in the serum, and
the fifteen obtained by the previous bleeding, twenty-eight. Speci-
mens were sent immediately to Mr. Rhind, the naturalist, who gives
the following description of them :—
‘‘ The animals I received from you lived with me two days, in a
little blood serum, when I had an opportunity of examining them
most attentively. They are from about half an inch to six or eight
lines in length ; when dead the bodies relax and become about one
inch long. They consist of an articulated body of eleven joints, of
a head with rudiments of four organs, (antenna: and palpi,) with an
appendage immediately below the articulation of the head, which is
ciliated, and very similar to the respiratory tubes at the other extre-
mity. The tail terminates in two tubular bodies or stigmata, having
ciliated margins; they are the external respiratory organs; besides
these, there are two or three bands on each side, which are mere
fleshy appendages. Within the articulated body, extending on each
side from the tail to the head, the respiratory organs are distinctly
visible with the aid of a microscope. They consist of a continuous
tubular structure, of a pale silvery colour, through which the air
passes. ‘The colour of the animals is bright-red. These animals
exactly correspond in structure, cclour, and size, to the larve of the
Lipula oleracea which in summer is so abundantly found in ditch or
river water, The eggs of these flies are very minute, and at a cer-
tain season of the year are deposited in great numbers in running
water, by the Tipula fly, well known by its long legs and slender
body. The worms cannot be mistaken for any of the Entozoa of the
human body, or of other animals, because they have distinctly formed
aerating organs, which intestinal worms never have been discovered
to possess. They are in many points entirely different. Their red
colour is a specific distinction, and not likely to be accidental, from
the colour of the fluid in which they were formed, and on which they
appeared to feed. They also seemed to respire equally well in the
blood serum as in water, for I could distinguish a constant succession
of air globules in their respiratory tubes.” |
The short. monograph from which the above account is extracted
contains a brief view of the narrations given by various authors of
similar occurrences, and a discussion of the various theories of their
formation, to which, as we have not space here, we must refer the
reader.
324 Scientific Intelligence.
A Case of Scorching by Electric Fluid, by M. Volpeliere of
Arles.—A very delicate woman, sixty-eight years of age, of a ner-
vous, bilious temperament, while closing her window on the evening
of 26th of May, 1829, during a violent thunder-storm, with torrents
of rain, was struck with lightning. The electric fluid proceeded from
the iron fastening of the window along her left hand and sleeve, till
it reached her shoulder, whence it descended along the thorax, ab-
domen, groin, internal part of the thigh and leg, to the sole of the
foot, keeping always on the same side. She fainted, fell backwards,
and sustained a contused wound in the occipital region. After re-
maining an hour in this state of stupor, she with difficulty got up,
and threw herself on her bed till day break, when she called her
neighbours. On visiting her soon after, M. Volpeliere found her
with a wandering countenance, feeble. concentrated pulse, and cold
skin. - All the parts touched by the electric fluid were scorched. In
some places the epidermis was raised, and the thigh presented an
erysipelatous redness. Simple cooling dressings were applied, and a
stimulant exhibited. Ona second visit, the strength was a little re-
stored. On examining the patient more minutely, it appeared that
the skin had acted as the conductor of electric fluid. The sleeve of
the shirt was not burned, except at the shoulder, where, at the time
of the accident, the arm formed with the body an of angle 46°. She
had a cloth under-vest lined with scarlet. Wherever the electric fluid
had been delayed for a longer or shorter period, the scars were larger
and deeper. The wrist, shoulder, upper part of the pelvis, were se-
verely burned. The inner surface of the thigh, at first of an erysi-
pelatous red, presented soon after the reaction an enormous wound.
The leg confined by the garter did not arrest the course of the fluid.
There were observed here only two holes, one below the knee, and
the other above the malleolus internus. Reaction took place se-
veral times, but was subdued by abstinence. After the separation
of the eschar, the cicatrization of this enormous wound took place ;
but upwards of two months after the accident, the patient died of
gastro-enteritis.
Wound of both Femoral Arteries without Hemorrhage.—An
artilleryman, while standing with his legs asunder near a cannon
which he was preparing to sponge, was struck by a bomb, which burst,
passed between his thighs, from behind forward, without fracturing
either femur, and tore all the soft parts situated at the middle-third
of the internal and posterior side of these members. No hemorrhage
ensued, though the two femoral arteries appeared, amid the havoc
of the soft parts, completely divided, and exhibiting a motion altoge-
ther erectile. The pulsations of both were very perceptible superiorly,
till within three or four lines of the divided extremities, where a sort
of resistance to pressure was felt, as if the orifices of the two arteries
had been stopped by a foreign body. It was true torsion of the vessels.
It is almost needless to add, the patient did not survive.
THE:
DUBLIN JOURNAL.
OF
MEDICAL AND CHEMICAL SCIENCE.
1 JULY, 1834.
; PART I.
ORIGINAL COMMUNICATIONS.
Arr. XVIIL—On Rupture of the Peritoneal Coat of’ the
Uterus. By Francis Wurrz, M. R.C.S., Surgeon of St.
Anne’s Dispensary, &c. &c.
(Read before the Surgical Society of Ireland.)
THE following case, which occurred some time back, I beg leave
to offer to the notice of the Society ; it is different in many par-
ticulars from the only two cases on record of rupture of the
peritoneal coat of the uterus, and therefore will, I trust, not be
found alicgether devoid of interest.
Mrs. W—=, a highly respectable lady of this city, aged
32, well formed, married fifteen years, the mother of eight liv-
ing children, had nearly gone to the full period of utero-gesta-
tion of her ninth child, when on the 10th December, 1824,
she met with some fright that caused her to turn round quickly ;
she was at the same moment seized with pain in the lower
part of her back, which extended round to the abdomen, at-
VOL. v. NO. 15. 2uU
326 Mr. White on Rupture of the
tended with a sense of faintness and great palpitation of the
heart. She recovered soon from the immediate effects of this
shock, and being of a very cheerful disposition, and of an active
turn of mind, no further apprehensions were entertained either
by herself or those about her, although it was observed she
looked paler, and appeared more languid than usual. How-
ever, she attended to her domestic affairs until the morning of
the 18th, when going up stairs she was attacked with darting
pains in the lower abdominal region, attended with a peculiar
sensation which she could not well describe ; she became agi-
tated, pale, and ghastly. A late eminent accoucheur was im-
mediately sent for, who found her labouring under great diff-
culty of breathing, threatening suffocation, pain of her heart,
pulse quick and fluttering ; there was no appearance or symp-
tom of her labour coming on, and seeing her situation becom-
ing more alarming, Dr. Cheyne was called in in consultation.
About nine o’clock, Pp. m., Mrs. W—— was seized with labour,
and after a few feeble uterine pains, she was delivered of a full
grown still born male child; but in less than three quarters of
an hour she gradually sunk and expired.
In the post mortem examination which took place in two
days after, and in which I was assisted by Mr. Colles, the Se-
nior Professor of Surgery, the following were the appearances
which we observed and noted :—
Cavity of the Thorax.—Considerable serous effusion into
the right side ; on the left, there were adhesions of the pleure,
and some effusion ; the structure of the lungs healthy; the heart
empty, its walls flaccid ; valves of the arteries without diseased
appearances.
Abdominal Cavity.—On opening the abdomen, a large quan-
tity of fluid blood was found in the vicinity of the uterus, the broad
ligaments of which were injected with blood; the uterus had not
contracted ; the right ovarium was much enlarged, and contained
two hydatids of considerable size ; on the anterior surface of the
uterus were two long tears or lacerations, and one of smaller size
Peritoneal Coat of the Uterus. 327
through the peritoneal coat, and also through a few superficial
fibres of the uterus, from which the blood had issued. All the
other parts, both of the pelvis and abdominal cavity, were per-
fectly sound, and on opening the cavity of the vagina and uterus,
nothing was observed except what is usual after parturition.
Such were the appearances which presented themselves to
our view. The heart had been emptied of its last drop, and
the abdominal cavity filled with almost the entire blood of the
body, which had flowed through those three superficial rents.
From the detail of the above untoward and melancholy
~ case, a few observations may be deemed net out of place or in-
appropriate, and therefore I do not hesitate in submitting them
to your impartial consideration.
It will be perceived that the above case was from the com-.
mencement involved in obscurity, that it was not attended with
the usual characteristic marks of lacerated uterus or injuries of
its appendages. There will be found some striking differences
between it and the two cases already alluded to, and which might
at first view be considered as bearing a strong. resemblance
_to it.
The first case is by Dr. C. M. Clarke, in the third volume
of Transactions for the Improvement of Medical and Surgical
Knowledge.
«< A woman between the age of twenty and thirty was taken
ill of her first child at & o’clock, a. m., attended by a midwife.
She went on gradually in regular labour for about two hours,
when she was suddenly seized with pain in the abdomen and
nausea ; great irritability succeeded, with faintness and exces-
sive restlessness, and at half past 10 o’clock, pr. m., she died un-
delivered, immediately after which a dead child and the pla-
centa were extracted. |
«‘On examination there were no morbid appearances to be
found in the abdominal cavity, or any of its viscera. The
uterus somewhat contracted. On viewing its posterior sur-
face, about an ounce of blood was observed lying m the fold
328 Mr. White oz Rupture of the
of the peritoneum, where between forty and fifty transverse la-
cerations were discovered, none of which were in depth more
than the twentieth part of an inch, many of them appearing
merely fissures, and varying considerably in length from the
fourth part of an inch to two inches ; they occupied the greater
part of the posterior portion of the uterus, and were thinly co-
vered with flakes of coagulated blood. ‘The muscular poe of
the organ was perfectly sound.” :
In this case it will be remarked that those alarming symp-
toms with which the patient was seized, occurred two hours
after regular labour had taken place, that she died undelivered,
and that the appearances on dissection, discovered those slight
lacerations in the peritoneal coat.merely, the muscular structure
not being in the least implicated, and that about an ounce of
blood was effused into the peritoneal fold ; upon the whole, it is
difficult to account for this woman’s death, and Dr. Clarke
does not account for it satisfactorily, and appears to incline more
to the opinion of its being the result of disease, than as the effect
of an accident occurring during labour, or being immediately
consequent upon it.
The second case is in Dr. Ramsbotham’s work on Mid-
wifery, page 409. “A lady who had the previous evening been
delivered of her seventh child, after a tedious labour ; she gra-
dually sunk, and died somewhat suddenly the following morn-
ing. No particular occurrence to excite alarm had happened’
during labour, nor was there any external flooding. On dividing
the abdominal parietes a considerable quantity of blood was
observed in the cavity of the abdomen; the viscera generally
were healthy ; on bringing forwards the uterus, which was well
contracted for the time, a rent of several inches in length was
discovered in the peritoneal coat, on its posterior surface, ex-
tending nearly to the insertion of the left broad ligament, in
which the fleshy structure of the uterus did not seem to be en-
gaged.”
The fatal result of this case can be fairly attributed to the
Peritoneal Coat of the Uterus. 329
tedious and difficult labour, and undue degree of pressure of the
distended uterus against some portion of the lumbar vertebra or
angle of the sacrum, would account for this extensive laceration
in the peritoneal coat.
Respecting this case, I shall merely observe, that it bears a
stronger analogy to the one which I have recorded than that
of Dr. Clarke ; however, there may be found some shades of
difference ; first, the symptoms which indicated danger did not
set in until after the patient was delivered, and secondly, the
appearances on dissection presented this material difference,
that the injury was confined to the peritoneal covering.
Having thus advyerted to the only two cases which I have
been able tofind bearing upon the present subject, I shall now
briefly comment upon the case immediately under our conside-
ration. First, then, the injury which led to her death was
caused by the exertion occasioned by the fright which occurr ed.
some time previous to delivery, and _ totally unconnected
with it; and secondly, the symptoms denoting such, were of so
equivocal a nature, as to be calculated to deceive the most ex-
perienced practitioner. For though it was almost obvious she
was labouring under internal hemorrhage, yet there were no
positive or conclusive symptoms to indicate its having an uterine
origin ; and thirdly, as [have before stated, the lacerations pe-
netrated into the muscular structure of the uterus, and, it will
be observed, were confined to the anterior portion of the organ.
It is a matter worthy of consideration, whether, if the real
nature of the injury had been known, any chance of saving the
patient would have been afforded, by inducing premature labour
and an early extraction of the child ; the consequence of which
might have been a contraction of the uterus, and, in all proba-
bility, a cessation of the hemorrhage.
In this view I am supported by Dr. Charles Johnson, our
Professor of Midwifery, whose experience and scientific acquire-
ments in this particular branch of the profession entitle his
opinion to the highest consideration ; and who states in a letter
330 Mr. White on Rupture of the
to me, on perusal of this case, that, “ Rupturing the membranes,
by allowing the uterus to contract, and thus diminishing the
calibre of the vessels, might, in your case, have checked the
hemorrhage ; but most probably would not have altered the
event of the case; for we find by Dr. Clarke’s case, that this
injury of the uterus may prove fatal without hemorrhage to any
extent. ‘The rupture of the membranes would likewise have
been the means of expediting the labour; and we know that the
chances of recovering in all cases of ruptured uterus, are much
lessened if the woman is not immediately delivered.”
In conclusion, I have to observe, that there is no subject
connected with the practice of surgery and medicine, that de-
mands so careful an investigation as the causes of sudden death
which occasionally occur during pregnancy, and which, in my
opinion, have been too much overlooked by practitioners. It
admits of little doubt, but by attention to this very important
subject, the profession may be enabled to ascertain, by post
mortem examinations, the true nature of such accidents, and
thereby arrive at a more accurate knowledge of the mode of
treatment. Even if we cannot deduce any practical inference
from the case under consideration, it may be valuable, by throw-
ing additional light on a subject hitherto involved in obscurity.
{t is then with these views, that [have brought forward the pre-
sent case, in order to encourage the junior portion of our pro-
fession, to pay that attention to the subject which it so particu-
larly merits.
The following note from Dr. Montgomery throws additional
light upon this subject :—
‘¢ 18, Molesworth-street,
“ February 20, 1834.
«¢ My DEAR Sir,
«‘ While listening to the detail of your very in-
teresting paper on peritoneal rupture of the uterus, read before
the Surgical Society, it occurred to me that I had met with an
account of another case, besides those to which you referred,
Peritoneal Coat of the Uterus. 331
and on turning to the notes of my lecture on the subject, I find
the following case quoted: ‘A patient during labour suddenly
complained of unusual pain and distress, and presented the most
alarming symptoms, without any evident cause. She was, how-
ever, safely delivered by the natural efforts of the uterus, but
fell into incoherence, jactitation came on, and she died within
six hours after delivery.
“««¢'The body was examined next day, and a large quantity of
blood was found effused into the cavity of the abdomen. The
uterus was firmly contracted, and posteriorly, near its fundus,
was found ruptured to some considerable extent. The surface
of the rent was covered with portions of coagulum: it occupied
a space perhaps as large as a crown piece, but of irregular mar-
gins, and surrounded by a reddish stain, giving it, at first view,
the appearance of having resulted from ulceration. Near this
large breach were three or four smaller cracks in its substance.
Upon cutting into the cavity of the uterus, it was found that the
rupture had not extended into it, the lining membrane being
entire throughout, and a considerable portion of muscular sub-
stance intervened between it and the external rent, which per-
haps had not penetrated more than two-thirds through it. The
uterus seemed sound in all other parts of its structure.’
“ You will find this account in the London Medical Gazette
for August, 1832, p. 630, by Mr. Chatto, and it might be sa-
tisfactory to you to add it as an additional reference connected
with your very important case, and no less judicious observa-
tions thereon. :
‘¢ T remain, dear Sir,
‘“‘ Very truly your’s,
“W. FEF. Montcomery.”
332, Dr. Blackley on the Cause of the Pulse being
Art. XIX.—On the Cause of the Pulse being affected by the
Position of the Body. By Travers R. Buacktey, A. B.,
Member of the Royal College of Surgeons in Ireland.
(Read before the Surgical Society of Treland.)
Untix the appearance of Thompson’s work on Inflammation,
the attention of the medical world does not seem to have been.
drawn to the fact, that the position of the body has considerable
influence in modifying the action of the heart. In speaking of
the effects of the cold bath in lowering the pulse, he makes a
few observations on the subject : |
«The pulse,” he says, ‘‘ even in a state of health, is more
frequent by from twelve to twenty beats in the minute in the
perpendicular than in the horizontal position. This difference,”
he adds, “ was pointed out to me for the first time many years
since by Doctor Mac Donnell, of Belfast.
From this time little seems to have been done either by
physiologists or pathologists to account for these phenomena.
I am not aware of any work purporting to have this for its ob-
ject, and for many years we have contented ourselves with the
very insufficient explanation of those varieties being caused by.
muscular exertion. So little interest, indeed, had the subject
created of late years, in relation to either physiology or thera-
peutics, that I believe I would be justified in asserting that the
majority of medical men, previous to 1830, were either ignorant
of the fact, or had ceased to regard it as of any moment what-
soever. At this time public attention was revived by an able
and valuable paper from the pen of Dr. Graves, “ On the Effects
produced by Posture on the Frequency and Character of the
Pulse in Health and in Disease,” which appeared in the fifth
volume of the Dublin Hospital Reports, 1830, and which, for
closeness of observation and accuracy of experiment, is no less
interesting to the physiologist than to the medical practitioner.
“ Tn healthy persons,” he observes, “ the pulse in the erect pos-
ture is more frequent than in the horizontal by from six to fif-
affected by the Position of the Body. = 333
teen beats in the minute. If the pulse is but sixty, the differ-
ence is generally not more than six or eight, and this difference
increases with the frequency of the pulse at the time of the ex-
periment ; thus, if it has been raised to 90 or 100 by moderate
exercise, it is not unusual to find the difference twenty or thirty.
[ need scarcely add,” says Dr. Graves in conclusion, “ that I
cannot advance even a plausible conjecture concerning the rea-
son why a change of position should so affect the frequency of
the pulse.”
These last words stimulated my curiosity, and led me to the
following conclusions in explanation of the causes of the heart’s
action being influenced by the position of the body :—
I believe it will be readily conceded, that the action of the:
heart in a strong and healthy individual, while in a state of rest,
is uniform and equal, that it is possessed of a power sufficient
to expel a certain quantity of blood at each contraction of the
left ventricle, which power is necessary to overcome the obsta-
cles presented to the egress of the blood. }
Let us suppose, for instance, that the heart. of a healthy man
in the erect posture beats sixty times a minute, and at each beat
expels one ounce of blood, sixty ounces per minute will be of
course expelled ; but if the power of the heart be increased or
diminished, we must expect a corresponding alteration in the
number of beats. Thus, if the power be izcreased one-tenth, —
it will require but fifty-four beats to expel sixty ounces in a mi->
nute ; but if it be diminished one-tenth, it will require sixty- “SIX
beats. | :
To this variation of power in the heart are the phenomena
of which we speak attributable, or rather I should say, the
variation of resistance to the heart, which comes to the same
thing. A question may here be asked, namely, “can you prove
that the heart discharges a greater quantity of blood at one
time than another, or that the left ventricle does not at each
contraction expel the entire of its contents ””
VOL. vy. NO. 15, 2m
334, Dr. Blackley on the Cause of the Pulse being
I am fully aware that the general. opinion is opposed to
mine ; indeed, actual experiment would. seem to be against me,
for it has been affirmed, that on inserting the finger into the left
ventricle of a recent heart, it contracts through its whole extent ;
nevertheless, I think I can prove the reverse, from the anatomy
and mechanical construction of the heart itself.
1st. There are no muscular fibres going from the substance
of the left ventricle to be inserted into the opposite edges of
the valves, or above them into the aorta; therefore the space
immediately inferior to the valves cannot be compressed.
2dly. We never find the left ventricle perfectly closed after
death, even though it should be at the time that rigidity of the
muscular fibre prevails.
3dly. If the valves had no support, as by a certain quantity
of blood under them, to act asa counter pressure, they would be
liable to injury from the superincumbent mass of blood in the
aorta.
4thly. A vacuum being formed by the expansion of the ven-
tricle, the valves would be drawn downwards with considerable
force to fill it up, and thus an additional weight be unnecessarily
imposed on them.
Lastly. In a very rapid pulse, say 160, we can scarcely con-
ceive the. sides of the left ventricle to be closely approximated
through their whole extent at each pulsation, and separated
again, the usual quantity of blood as in health being expelled
at each contraction. But we can readily admit that such a
number of palpitations may be effected, the ventricle contract-
ing but slightly at each beat; or a very small quantity of
blood may be contained in the ventricle at each contraction,
and thus supersede the necessity of the ventricle being much.
dilated ; and we may observe, that in those cases where the
pulse is so frequent as I have mentioned, it is never full and
strong, but on the contrary, weak and thready, evidently proving
that a very small quantity of blood indeed is forwarded at each
contraction of the ventricle.
affected by the Position of the Body. 335
To resume. Let us consider the relative force of resistance
to the heart’s action in the erect and horizontal positions of the
body. In the former we have the column of blood in the
arch of the aorta assisted by that in the carotids pressing on the
semi-lunar valves, and opposing the egress of blood from the
left ventricle. Next, we find that the arteries being all full, a
considerable vis a tergo is required to force on the blood which
they contain, especially through the carotids, where it must be
driven upwards. But by far the greatest obstacle to the action
of the left ventricle, and that which is the chief cause of the
non-permanency of the pulse, is presented by the veins; if the
arteries require the vis a tergo, the veins require it in a much
greater degree, not only from the nature of their structure,
which is inelastic, but that their contents, contrary to the laws
of gravitation, must for the most part be forced directly up-
wards to the heart.
In the horizontal position those obstacles are lessened or re-
moved ; the blood in the carotids and arch of the aorta does
not press with such force upon the valves, but chiefly the veins,
namely, all those below the heart, being placed in the most
favourable position for spontaneously returning their contents,
remove an immense obstable to the egress of blood from the
left ventricle. Hence it follows, that less resistance being op-
posed to the heart in the horizontal position, and the same
power exerted, a greater quantity of blood is propelled at a
time, and consequently the number of pulsations necessary to
transmit the same quantity in a given time in the erect posture
diminished.
The frequency of pulsation then is in a direct ratio to the
obstacles presented to the heart’s action, whether those be me-
chanical or arising from debility of the heart itself. On the
supposition of the correctness of this view, can be explained, I
think, all the phenomena so closely observed by Dr. Graves.
“As the muscular exertion necessary to keep the body in
336 Dr. Blackley on the Cause of the Pulse being
ihe erect posture,” observes Dr. Graves, “ might be considered
as the cause of this greater frequency, it became necessary to
contrive means of placing the body in any desired position,
without the necessity of muscular exertion on the part of the
subject of the experiment. This was effected, and it was found
that when the posture was changed by means of such a con-
trivance, the difference between the frequency in the horizontal
and erect postures was not less than when muscular exertion
was used.” . The theory of muscular exertion then being the
cause, is set at rest for ever. “I now anticipated that if the
body was placed with the head down and feet up, a still fur-.
ther retardation of the pulse would be produced. It was, in-
deed, natural to suppose from the preceding experiment, that
posture alone was the cause of the retardation observed in the
body. when placed horizontally, and, consequently, that this
effect would be augmented on still more depressing the head,
and that the maximum of retardation would occur in the inverted
position. Here, however, as it not unfrequently happens, pre-
conceived ideas were not found to accord with experiment, and
no further retardation was thus effected ; neither, on the other
hand, was it accelerated beyond the number observed in the
horizontal position.”
I quote Dr. Graves thus fully, and am anxious his experi-
ments should be borne in mind, as the observations they sug-
gest will serve materially to elucidate the grounds by which my
theory is to be supported. |
Thus, in respect of the foregoing observations, although in
the inverted position there certainly is a greater facility for the
return of the blood contained in the veins below the diaphragm
to the heart, yet a new obstacle is offered to the action of the
left ventricle in the relative position of the arteries. The blood
in the aorta, iliac and femoral arteries, &c. &c., must in this
position be forced upwards, instead of gravitating to a certain
extent downwards, as they do in the erect posture, and. the
blood in the veins of the head, neck, &c. will require a greater
affected by the Position of the Body. 337
vis a tergo to be forced upwards to the heart. Hence I think
we might readily deduce a rule to ascertain the relative force of
opposition in the veins and arteries to the action of the heart in
the various positions of the body. Thus, if in the erect posture,
the most favourable for the transmission of blood in the arteries,
and most unfavourable for the veins, the heart contract eighty
times a minute, and in the horizontal or inverted position, the
most favourable for the return of the venous blood, and unfa-.
vourable for the arterial, it beat only sixty times, I conclude
that the resistance opposed by the veins is one-fourth greater
than that offered by the arteries. The easiest posture, then, in
which the heart’s action can be carried on, is that in which the
arteries and veins are as little antagonized as possible, namely,
the horizontal.“ It is very singular,” says Dr. Graves, “ that
a posture so unnatural as the inverted should produce no effect.
on the frequency of the pulse as compared with the horizontal,
while a change from the latter to the erect, both natural pos-
tures, is attended with so great an acceleration.”
The reason is obvious ; the opposition to the heart’s action
is the same in the two positions, the horizontal and inverted,
the increased resistance in the arteries in the latter position be--
ing exactly balanced by the increased facility for the return of
the venous blood, whilst in the erect posture the resistance of.
the veins is much increased over that of the arteries, and the ge-
neral opposition to the heart much greater than in either of the
former positions. “In the inverted position,” he continues,
“although the frequency of the pulse is not altered, its strength
is diminished, and often very considerably ; it is not unusual too
for it to become irregular, a fact that may be explained by the
greater weight of the blood pressing back on the aortic valves,
- and then necessarily opposing an unusual impediment to its egress
from the left ventricle.” os
I would suggest that the diminution of strength of pulse,
observed in the inverted position, may in some manner be attri-
buted to the pressure on the brain, or to the very unusual posi-
338 Dr. Blackley on the Cause of the Pulse being
tion of the heart, which 1s now turned upside-down, and its
strength and mobility thus lessened and confined. The same
causes may exercise their influence im causing irregularity, but
this latter is, I think, more directly referrible to the superabun-
dant quantity of blood, which in this posture is thrown into the
right side of the heart, and which thus prevents the equilibrium
being maintained between the two ventricles, and is not to be
attributed to pressure on the valves, as there is at such a time
much less pressure, than in the erect position when no such
irregularity exists.
«The pulse,” he adds, “is also evidently stronger in the
horizontal than in the erect posture, consequently its maximum
of strength, and minimum of frequency, are attained together.”
I would here remark, that the increased strength and (we
may add) fulness of pulse observed in the horizontal position
compared with the erect, depends on the resistance to the heart
being diminished in the former, and a greater quantity of blood
consequently expelled at each contraction, the quantity of blood
being thus increased the number of pulsations required to trans-
mit a given quantity is diminished, as I have already explained,
whereas if the quantity of blood was diminished the number of
pulsations would be increased. Mr. Adams, in his paper on
diseases of the heart,* gives a case in which he expresses him-
self in harmony with this opinion.
«In consequence,” he says, “ of the shortening of the valve
it imperfectly covered the auriculo-ventricular opening, and too
readily allowed of a reflux of blood into the left auricle during
the contraction of the ventricle. Hence the effort of the heart,
instead of being, as it is in the natural state, expended in pro-
pelling the blood onwards through the aorta, was partly lost,
because of the imperfect state of the valve admitting a regurgi.
tation of some of the blood which was destined to pass into the
aorta. The heart was obliged therefore to reiterate its beats,
a cence a ane a a ga em gE
* Dublin Hospital Reports, vol. iv.
affected by the Position of the Body. 339
to compensate by its quickness for that small quantity of blood
_ ut was incapable of furnishing at one contraction through the
aorta.”
Dr. Graves now proceeds to make some observations which
are highly interesting, and which serve to prove pathologically,
(should any doubt remain,) the correctness of the theory I have
advanced.
“In all other diseases in which I have investigated this
subject,” he says, “I have found a difference between the fre-
quency of the pulse in the erect, sitting, and horizontal postures,
but in six cases of hypertrophy with dilatation of the heart, no
such difference was perceptible, although all these patients at
the time of my making the experiment were in a debilitated
state, which is that in which the changes induced by position
are the most remarkable.
“‘In those cases the hypertrophy and dilatation were very
great, and in five of them certainly, (examined after death,) and
in the sixth probably, the left ventricle was involved in the dis-
ease, and I am inclined to think that this permanency of the
pulse in all positions of the body, will be only found to exist
in such cases, and not in those where the hypertrophy and dila-
tation are less considerable, and consequently the diagnosis
more obscure. ‘This circumstance may, it is true, detract
from the value of the observation, so far as regards diagnosis,
but certainly does not diminish its physiological interest.
“T may observe too, that should future observations prove
that hypertrophy of the heart is not always attended by this
permanency of the pulse,* and I believe it 1s not, yet its occur-
rence in so many cases of that affection is nevertheless an inte-
resting fact.”
* From a conversation I had with Dr. Graves, a few days ago, it appears that
since the above was written, now four years, he has in his very extensive practice
uniformly observed that permanency of pulse is caused by hypertrophy of the left
ventricle.
340 Dr. Blackley on the Cause of the Pulse being
Nothing can be more satisfactory than those remarks, they
prove that the left ventricle being possessed of a certain addi- —
tional power, namely, sufficient 10 overcome the resistance
offered to the heart, in all positions of the body, that perma-
nency of the pulse is the consequence, and therefore I think it
follows that the non-permanency of pulse, or the variation of it,
depends on the inability of the heart to overcome the resistance
opposed to it, with equal facility in all positions.
The state of the valves, however, as Dr. Graves very accu-
rately remarks, must have considerable influence in modifying
the action of the heart, for on their integrity, as we may readily
perceive, depends in a great measure the relative resistance op-
posed to the left ventricle, yet we may conceive the same effect
“permanency of pulse,” to be produced in two very different
states of disease, namely, hypertrophy with and without val-
vular disease. ‘Thus hypertrophy to a certain extent, assisted
by valves in a healthy condition, may cause permanency of pulse,
while hypertrophy to a much greater degree, even though the
valves be obliterated, may give rise to the same effect, the in-
creased muscularity and consequently power in the latter case,
being equal to the assistance afforded by healthy valves in the
former.
A question arises. If increased muscularity or hypertrophy
be acquired by the heart, in consequence of the obliteration of
the valves, what would be the result, if the valves became so
strengthened as to remove in a great measure the pressure of
blood from the left ventricle? I reply, diminished muscularity
or atrophy. This I am fortunately enabled to prove by reference
to Mr. Adams’ treatise on diseases of the heart,* in which the
following case occurs, one, the most interesting and extraordi-
nary perhaps that has ever attended pathological research,
namely, the change of the muscular structure of the heart into
fat.
JAG Ta eae errr es OF ie eee
* Op. cit.
~ affected by the Position of the Bedy. 341
“The right auricle was much dilated, the right ventricle
externally presented no appearance whatever of muscular fibres,
it seemed composed of fat throughout almost its whole sub-
stance. ‘The left ventricle was very thin, and its whole surface
was covered with a layer of fat, beneath this the muscular struc-
ture was not a line in thickness.” |
This I think will be readily admitted to have been a com-
pletely atonic condition of the organ, but let us inquire the
cause. <“ Indeed the left ventricle was so weak, and its parietes
so reduced, that, at first sight, it created our surprise that it was
at all capable of carrying on the circulation, which was not a
little increased when on a close examination it was discovered,
that the valves of the aorta had become, from cartilaginous and
earthy depositions, so rigid as to retain water, whether poured
upon them from the artery or the ventricle, the contact of their
edges was preserved in such a manner, that it required that a
fluid should be injected from the heart with some little force to
render this arterial opening pervious.” This case speaks vo-
lumes, it is an additional proof of the immense influence which
the valves exercise over the action of the heart, and it serves to
place in strongest contrast, two opposite states of disease induc-
ed by the condition of the valves, namely, atrophy, as in this
case, caused by the unusual strength of the valves, and the sup-
port afforded by them to the column of blood in the arteries,
superseding the necessity of the usual muscularity of the ven-
tricle, compared with hypertrophy induced by obliteration of
the valves, and the consequent necessity of increased muscula-
rity, to overcome the additional obstacles consequently present-
ed to the egress of the blood. This, at first sight, may appear
contradictory, as the state of the valves presented an additional
‘obstacle in itself, but let us recollect, that the heart, like other
ergans, may accommodate itself to changes, when effected gra-
dually, that would cause instant death if suddenly induced.
While speaking of the valves, and the influence they exert,
it may not be uninteresting to mention that Haller was fully
VOL. Y. No. 15. ay
342 Dr. Blackley on the Cause of the Pulse being
aware of the effect produced by them, when in a diseased state,
on the heart, though not perhaps quite clear as to the cause:
In his work, De Partium Corporis Humani Fabrica et Func-
tionibus, he gives several instances, among others the follow-
ing: “Valvulee aorte contracte ut sanguis in cor rediret, hine
ventriculus sinister, dextro amplior.” Again, “Cum eadem
ostiola ossea forent, et sanguinem retrogradum in cor admitte-
rent, cor sinistrum amplissimum.”
Very many practical results and inquiries are deducible
from’ the foregoing observations, not the least useful of which
would be the relative degree of hypertrophy induced by the
various morbid conditions of the valves ; and also the propriety
of lessening the mass of the circulation, and removing the re-
sistance to the heart by observing the horizontal posture, in ould
pertrophy asa primary and uncomplicated disease.
It has been observed; that the greatest variety in the fre-
quency of the pulse on change of posture occurs in persons
labouring under fever, or debilitated in consequence of that or
any other cause, amounting in some cases to so great a differ-
ence as even fifty between the erect and horizontal positions,*
and this we might expect on considering the structure of which
the heart is composed, and the purposes it serves. )
It is a muscular organ, and participates with the other mus-
cles of the body in the general debility of the frame in sickness ;
not being able to overcome the obstacles presented to the egress
of the blood in ‘the erect posture, in as few pulsations as in the
horizontal; it is forced to contract the more frequently im order
to transmit the same quantity of blood in a given time as in the
latter position, at least it makes an effort to do so, and this
ereater variation is therefore a good diagnostic sign of the
general debility of the patient and vice versa; of course when
the patient lies down the pulse falls to its former standard, the
obstacle which caused its increased action being removed, in
=
* Dr. Graves op. cit,
affected by the Position of the Body. 343
other words, the veins now empty themselves spontaneously,
instead of requiring the vis a tergo from the heart to propel the
blood through them, consequently the resistance to the left
ventricle is lessened. It sometimes, however, happens, that the
pulse does of fall to its former standard on the person lying
down, and the cause is interesting.
On assuming the erect posture from the horizontal, (when
_much debilitated,) the heart is affected in two ways, first, by
the irritation of an unusual stimulus, secondly, the actual ob-
stacle to the return of the venous blood ; where the weakness is
not toa great extent, it becomes accustomed to the irritation,
and consequently after some minutes falls a few beats, but still
remains more frequent than in. the horizontal posture, being
affected by the latter obstacle, the non-return of the venous
blood. It may, however, occur, that the irritation once induced
may continue, and the increased action of the heart be thus.
kept up, even after the patient lies down, and this isa good
diagnostic sign, as it indicates excessive weakness or irritability.
It has been observed by Dr. Graves, that in some persons the
- increase of frequency in the pulse is greater between the hori-
zontal and sitting postures, than Letween the latter and the erect,
while i others the contrary takes place, so that generally the
frequency in the sitting posture may be taken as a mean; this
is perfectly correct, and agrees fully with the theory I have ad-
vanced, for the femoral. vein in the sitting posture is horizontal,
and the weight of the column of blood from the feet to. the head
is broken, consequently the resistance to the left ventricle much
diminished. In like manner we may find, that if we now raise
the legs to a level with the thighs, we shall have a further retar-.
dation of the pulse by from two to four beats ;-this, however,
‘will depend much on the age and strength of the individual,
and on the healthy condition of the lower extremities in general,
and the veins of those parts in particular ; thus, where the limbs
are anasarcous, or the veins varicose, we may expect a greater
modification of the pulse in this position than where the legs are
344 Dr. Eager’s Considerations on Scrofula.
pending, while in a strong and healthy young person, little or
no difference is at times to be observed whether the legs are
perpendicular or horizontal.
Art. XX.—Some Considerations on Scrofula, and the various
means of Cure employed at the Children’s Hospital, Paris,
more particularly on the Effects of Iodine in the Treatment
of this Disease. By James Eacer, M. D., and House
Surgeon of the Paris Hospitals.
Ir there exist diseases which require strict attention, as well-
from their frequency and importance as the various forms under
which they present themselves to our view, the affection com-
monly denominated scrofula, may be said to belong to this
class. In the following pages, I purpose to examine the subject
as fully as the limits of a periodical will admit, under a conviction
that any reflections with a view to the prevention or cure of this
dreadful malady (too frequently a cause of despair to families)
cannot fail to be advantageous to the public. The task I pro-
pose to myself is difficult, however, being in possession of some
important data regarding the etiology and treatment of this
affection, it would be a great omission not to make them known.
Ancient writers have had a very erroneous idea of this dis-
ease, in considering it confined to the surface of the body. This
circumstance is attributable to their not having made post mor-
tem examinations, and consequently to a want of an opportunity
of comparing the symptoms with the lesions to which they be-
longed. We are indebted to Fernel, Plater, and particularly
the illustrious Morgagni, for our present knowledge of its nature.
These men, with the light of pathological anatomy, (of which
they may be considered the founders,) have established the
necessity of comparing the morbid symptoms observed during
life, with the disorganized appearances found after death ; and
Dr. Eager’s Considerations on Scrofula. 345
from their researches, since frequently repeated by: others, we
are bound to conclude, that, in considering this disease solely on
the surface of the body, we can have but a very inadequate idea
of its extent and importance. In effect, scrofula in its progress,
not only attacks the lymphatic glands of the surface, but also
the most important viscera and even tissues, such as the bones,
which differ widely in structure from these glands.
When the causes of a disease are obscure, it is generally
chosen as an arena for the discussion of the strongest and most
opposite opinions. This has been the case in the present in-
stance. Some have ascribed scrofula to the existence of a Virus,
others to the presence of acids and alkalies in the economy, and |
probably the greater number, up to the present century, believed:
it hereditary, viz. that the germ of it was transmitted from one
generation to another. .The natural conclusion from all these
suppositions is, that the disease bears the seal of antiquity, and
is very hard to be cured ; hence the necessity of well defining
its nature, of unravelling its real causes, of marking its progress,
its effects, the means calculated to prevent its development, and,
when it exists, the remedies to be opposed to it.
ON ITS. NATURE.
- The following exposé gives the most general idea of the na-
ture of this affection. It consists of tumours of a round form,
varying in size from a millet seed to a: turkey egg, sometimes
encysted, more frequently otherwise, single or numerous, iso-
lated or ina mass. These tumours are composed of the lym-
phatic glands, enlarged and indurated, or more frequently hav-
ing undergone the tubercular disorganization. In the latter
case, the substance which forms them is opaque, of a pale colour,
at first hard, like concrete albumen, ( periode de crudité,) after-
wards it becomes friable, soft, and finally liquid, like pus, ( pe-
riode. de. ramollissement.) Tn it we find no trace of organiza-
tion. It may exist in the tissues in an infiltrated state, such as:
_in the bones and around the articulations ; and although the
346 Dr. Eager’s, Considerations on Serofuld.
character of the affection does not change, the name of tubercle
is no longer assigned to it in this form.
The lungs, the mesenteric and: cervical glands, the prostate,
spleen, ovaries, brain, cerebellum, spinal: marrow, liver, and.
bones, are the organs most piguente attacked, and in the pres
just laid down.
It is obvious that fhe deceatesicn applies especially to whit
is termed ‘tubercle ; in scrofula, however, there, are other ap-
pearances which are better given with the symptoms:of the dis-
ease, particularly as the anatomical. examination throws no light
on their nature ; nevertheless, as scrofula, when confirmed, rare-
ly exists without tubercle, it becomes necessary to notice the
latter; at the same time avoiding to infer the identity of these
affections, from their co-existence, a conclusion which is inad-
missible in the actual state of our knowledge of the subject.
CAUSES OF SCROFULA.
In a scrofulous patient we have two distinct things to ob-
serve, viz. the predisposition and the actual disease. Although
authors admit that individuals of all temperaments may contract
this affection, yet they seem to think it has a kind of predilec-
tion for lymphatic constitutions ; a little reflection cannot fail
to show the extreme difficulty, if not impossibility, of establish-
ing this fact, admitting for a moment the existence of a lym-
phatic temperament, (which at most can be but a negative one,
and consequently a mere creation of the mind,) it would be ne-
cessary to study the effects of scrofula on equal numbers of this
and the other temperaments, in order to arrive at any thing like
conclusive evidence. Were I even to abstract from these re-
marks the very great difficulties which oppose the attainment of
this object, the numerical predominance in populations of what
are called lymphatic habits suffices to explain the frequency
with which these temperaments (when under the morbid influ-
ence of the causes of scrofula) become affected, and .conse-
quently precludes all possible necessity of attributing the fact to:
some peculiarity of texture.
Dr. Eager’s ‘Considerations on Scrofula. 347
g
The following are: the external marks ‘of this predisposition,
a fine white skin, delicate features, a florid’ ¢omplexion, an elevat-
ed and thickened upper lip, a precocious intelligence, a large
head, flat chest, a large lower jaw, dark colored teeth, which
soon become carious, a large belly, flesh flabby and soft, the
extremities of the bones thick and large, fair hair. This last
character offers very many‘exceptions: In my scrofula wards,
there are 56 boys and 74 girls, and of this number there are as
many with dark as fair hair.
These predisposing signs do not always exist, but when an
individual is so affected it is remarkable that he seldom escapes
the disease, unless by an unceasing attention, from the very com-
mencement, to the hygienic precautions which counteract this
disposition.
EFFICIENT CAUSES OF SCROFULA.
Many causes are said to originate scrofula. The continued
action of a cold moist air is with many authors the principal
one. I have abundant reasons to think that the absence of the
direct solar rays, and a long sojourn ina confined atmosphere,
contribute more than any other towards the development of
scrofula.
All physiologists are aware that these circumstances I men-
tion are calculated to give a predominance to the white liquids
of the body, to excite the action of the lymphatic system, and
to impart to the organization of animals and vegetables that re-
markable blanched appearance called “ etiolement.”
_ Thave questioned very attentively the parents of 74 scrofu-
lous children, and learned that of this number: 56 lived in low
houses with very small windows, on the ground floor, where the
direct rays of the sun never penetrated, and in which, though
very small, five or six persons slept. The remaining 18 belonged
to individuals in better circumstances, and although consequent-
ly better nourished, were in every other respect in the same
condition as the 56. The greater part belonged to the lower
classes. They were salceiod to great privations, and live in
» 348 _Dr. Eager’s Considerations on Scrofula.
rooms exposed to the north. ‘These circumstances augmented
the predisposition, and frequently brought on the disease’ in
.cases where this predisposition did not exist.
Inflammation is considered: a frequent cause of scrofula in
-all temperaments. All substances susceptible of becoming
-acid on the stomach are said to induce this disease. ‘An illus-
trious professor of this faculty thinks inflammation acts the prin-
cipal and exclusive part in its production. It is true inflamma-
tion has been frequently found to coexist with tubercles. Tu-
bercles seem sometimes produced in the brain by encephalitis ;
‘bronchitis, pneumonia, and pieuritis have often existed with
those of the lungs. Those of the mesentery are almost always
an effect of gastro-intestinal inflammation, those of the liver,
that of a chronic inflammation of the pyloric extremity of the
stomach and duodenum, and in some cases have even succeeded
hepatitis. |
These facts, although remarkable, are far from conclusive,
because inflammation does not give rise to tubercles without the
cooperation of other causes. Do we not often find inflamma-
tions terminate without tubercles or glandular indurations in
warm seasons, whereas the contrary is the case in opposite cir-
cumstances. We also find persons kept for a long time under
the influence of cold and moisture, and who nevertheless do not
become tubercular nor scrofulous, whilst others in a similar
situation are speedily affected. ,
It is worthy of remark, that the persons thus affected are
most commonly women and children, in whom the lymphatic
temperament predominates. I have five observations which offer
exceptions to this fact, they are of persons of a decidedly san-
guine temperament, in whom, by auscultation and percussion,
we could not detect the slightest sign of tubercles, but who,
nevertheless, in the course of traumatic fever, were seized with
pneumonia ; and this affection was speedily followed by the
most characteristic symptoms of pulmonary phthisis, M. An-
dral mentions in his work cases of mesenteric’ tubercles in
Dr. Eager’s Considerations on Scrofula. 349:
adults in which, after death, no trace of phlogosis was found.
Here I anticipate an objection. In the first case tubercles (mi-
liary) might have existed in the lungs in a latent state ; and all
‘stethoscopists know that in these circumstances it is extremely
difficult, without the help of premonitory symptoms, to detect
them. With regard to the second case, were we to judge from
analogy, we ought not to infer the absolute non-existence of
inflammation, from the absence of proofs @ posteriori, as we are
well aware that it is only when inflammation exists to a certain
degree that it leaves traces after death. There are erysipela-
tous affections of the intestines as of the skin, and in the latter,
during syncope, the result of bleeding, and after death, we
often find no traces of irritations that visibly existed, previously.
to these changes; moreover, the slightest irritation in one system
suffices to bring on a sympathetic one in another, which is dis-
posed to it. This we see every day. The use of farimaceous
food is said to determine tabes mesenterica and scrofula, and
this same cause may (according to some authors) bring on
phthisis. It is very remarkable that herbivorous animals con-
tract phthisis very frequently, whereas carnivorous ones are very
seldom affected. Butchers are also seldom attacked by it. Are
we to ascribe this exemption to their constant sojourn in an at-
mosphere charged with animal emanations? This is probable,
and the more so, as we are aware that good animal food is
amongst the most effectual accessary means of cure in scrofula.
It may be of use to persons threatened with tubercular phthisis,
to give a preference to animal food. This isa mere supposition,
although IT know of no facts to support it, yet it appears to
merit a trial. I have been induced to advert to phthisis in this’
article from the frequent occurrence of this disease in scrofulous
_ patients. In a word, if you examine a great many individuals
affected with scrofula, you will certainly find that when the dis-
ease is intense and of long duration, the lungs are almost con-
stantly affected with tubercles. This is so true that you may
conclude, d priori, when scrofula exists in a subject in its apo-
VOL. Vv. No. 15. 272
350 Dr. Kager’s Considerations on Scrofula.
gée, that the lungs or mesenteric glands:are the seat of tuber-
cular ‘masses. This latter fact is important as regards tabes
mesenterica, particularly as there are two states of this affection,
one in which the glands are simply indurated and a little en-
larged, and a second in which they have undergone the tuber-
cular disorganization. The first may be cured by judicious
treatment, but the second is incurable from the very fact that
tubercles are not resorbed ; and, as from their position in the
mesentery, they cannot be eliminated by the suppurative process,
they keep up a constant and destructive irritation which always
terminates by death. The reader, I presume, after having con-
sidered the greater number of the causes here laid down, has
come to a conclusion, that from their contradictory results they,
can, at most, be but accessary in their mode of action. ‘This
view appears to me very accurate. In the first place it is evident,
that in scrofula, all the economy seems to have undergone a
fundamental and profound modification from the influence of
causes the action of which has continued for a long time. Now
of all causes, none is more general in its action, none that
affects both rich and poor more frequently than foul, confined
air. It isan established fact, that pure air is indispensable to.
the healthy state of the functions, and that. when it does not con-
tain its due proportion of oxygen, it modifies the A@matosis in. a.
singular manner. In the first instance, through the medium of.
the lungs it impregnates the blood with a principle that pervades .
the body, giving health and life to the organs, by supplying
them with arterial blood ; whereas in the second, the blood not
having received:a necessary quantity of oxygen, passes into the.
system with its venous qualities, and by producing an. unheal-
thy action in the processes of assimilation and decomposition,
blunts the sensibility of the organs, and consequently produces
a morbid alteration of their functions. Hence that dulness, that
inactivity which we observe in individuals, who are, as it were,
saturated. with scrofula. Now if we take this view of the sub-
ject, and suppose all the other causes which are of a nature to ;
Dr. Kager’s Considerations on Scrofula. 351
determine irritations, to be brought into operation on an indivi-
dual so circumstanced, it is evident. that the effects of the
irritations which follow, cannot be the same as when the hama-
tosis goes on in the normal way; and hence it is, that when the
first condition, fowl air, does not exist, the other causes will
not determine the disease. The poorer classes in Palermo live
on the most miserable food, and in filth and poverty ; now, if
these causes were what is generally ascribed to them, these:
people ought to suffer from scrofula. The contrary, however,
is the case; and it is remarkable that they live in openair. What
are we to infer but that notwithstanding their poverty, &c. &c.,
their breathing pure air exempts them from scrofula. In a
word, I am satisfied that neither cold moist air, nor too nutri-
tious food, nor poor food, nor inflammation, suffice to induce
this disease without the action of foul air and the effect of the
absence of the direct rays of the sun. Were this fact well esta-
blished, of what importance would it not be to the manufacturing:
districts in our country, where this malady. is so prevalent:
From it would follow the necessity of keeping children and
other labouring persons in well ventilated and well situated
factories. I trust these remarks will direct the attention of ob-
servers who have an opportunity in these towns, to the conside-
ration of this subject; and I have no doubt but that their
researches will lead to such preventive means as shall, if not
entirely suppress, at least considerably diminish, the frequency
of this dreadful disease. ;
Scrofula affects more particularly the parts of the body in
which the vital functions are most active. In conformity witha
well known law of the economy, the liquids flow with more
force, and in greater abundance, towards the head in children
~ than in adults. Hence it follows that tubercles in the brain are
more frequent in the former than the latter, because the brain
in children is functionally the centre of a strong and continued:
action. However, this augmentation of vitality does not ex-
plain these morbid phenomena, for in old persons, although this:
352 Dr. Eager’s Considerations on Scrofula.
organ is the seat of extreme irritability, still tubercles are a very
rare occurrence. Scrofula in general comes on in children at
that period when a continued irritation is kept up about the
jaws by the process of dentition. In adults we find the lungs
affected with tubercles by reason of the activity of these organs
at this period of life. In older persons by reason of the predo-
minance of the abdominal viscera, tubercles of the liver prevail
almost exclusively, and those of the uterus in women. .
Some persons consider scrofula hereditary. This opinion’
cannot be admitted in the rigorous acceptation of the term, we
inherit from our parents a disposition to contract disease with
an organization like theirs, but not a germ of these diseases.
The children of parents who present no trace of the disease’
may become affected with scrofula. Persons too old or too
young, especially if their constitutions be impaired by excesses,
give birth to children badly formed and disposed to many affec-
tions, more particularly to scrofula. As to this disease being
contagious, there are too many opinions to the contrary on re-
cord, to render it necessary to insist longer on this point.
SYMPTOMS AND PROGRESS.
Preceded or not by redness of the eye-lids and a swelling
of the upper lip and nose, tumours appear, at first hard and
moveable, afterwards fixed, indolent or scarcely painful. ‘The
heat of the skin 1s not more than natural, its colour not changed.
These tumours occupy the sides of the neck under the jaws.
They form masses which impede the motion of the jaw, and
sometimes press on the trachea and vessels of the neck so as to
be, though rarely, mistaken for aneurisms of these vessels.
These tumours also appear in the groins and arm-pits. These
may continue indolent for several months, and seldom disappear
by spontaneous resolution. ‘They more frequently become soft,
after having considerably increased in size. In this last case,
the skin becomes very hot, has a shining, bluish, or brownish
red appearance, fluctuation becomes evident, ulceration follows,
Dr. Eager’s Considerations on Scrofula. 353
and from the tumour, which in its progress presented all the
characters of mild phlegmon, flows a thin serous pus sui generis.
‘The ulcer has an irregular form, its borders elevated, hard and
livid, its surface has a rosy colour, and is covered with exube-
rant granulations. _'The subcutaneous cellular tissue being in a
great degree destroyed, a decollement of the skin takes place.
This ulcer, when it does heal after a great lapse of time, is fol-
lowed by an indelible and very deformed cicatrix. The tumours
almost always contain large and numerous tubercles, and when
they suppurate, yield, on pressure, a cheese-like substance, which
leaves an immense and profound cavity after it. When the dis-
ease arrives at this period the viscera by way of sympathy con-
tract similar affections ; new diseases present themselves, with
phenomena peculiar to their seat and the functions of these
organs ; and under their influence the patient becomes exhaust-
ed, falls into marasmus, and dies. ‘The spongy extremities of
the bones are often affected. Potts’ disease may be considered
of scrofulous origin, mesenteric and pulmonary tubercles belong
also to it. When scrofula attacks the bones, the skin that
covers them ulcerates, after having presented the ordinary cha-
racters of mild phlegmon.. The borders of the ulcer are soft
and inflamed, the pain exquisite, and the surrounding skin more
or less affected. If you introduce a probe into the fistulous
trajets, the skin is found deprived of its cellular tissue, and a
sinuous passage leads to the bone, which also has lost its peri-
osteum, and is, for the most part, considerably softened. These
bones give a brown ichorous pus of a peculiar smell. ‘The
small articulations are most frequently attacked by this disease..
ITS PROGRESS.
Nothing can be more capricious than the progress of scrofula.
These tumours diminish im one place and appear soon after in
another. Scrofula may be complicated with syphilis, cancer, or
scurvy. Scrofulous tumours, like schirrus and some venereal
buboes, are at first indolent and hard, but they differ from
304 Dr. Eager’s Considerations on Scrofula.
them. Schirrus ordinarily succeeds inflammation, and lancinat-
ing pains reveal its existence. When it ulcerates, the surround-
ing veins become large and of a dark colour, a foetid sanies
flows from the ulcer, which is extremely painful. When scrofula
is complicated with syphilis, there exist pain, lassitude, ulcers
of the tonsils, pustules, gonorrhea, chancres, crests or rhagades ;
bleeding gums, carious teeth, and spots like echymoses indicate
the existence of scurvy.
ITS TERMINATION.
This disease ordinarily terminates by resolution or suppu-
ration. Death seldom occurs except from internal tubercles.
The termination by gangrene seldom or never happens. Pu-
berty often brings on a cure; there are, however, some excep-
tions ; nevertheless, it is not less true that it has a happy influ-
ence on the progress of this affection. The same may be said
of the effect of the spring season. At all events, the disease is
very serious, as well on account of the slowness of cure and its
deformed cicatrices, as the constancy with which the predispo-
sition is transmitted from parents to their children.
TREATMENT.
In order to effect a cure, it is necessary to attend scrupulous-
ly and with perseverance to the precepts of hygiene. ‘This is so
true, that, if neglected, there is no success to be expected from
any treatment, whereas if attended to, a cure is often obtained,
no matter what anti-scrofulous remedies have been used. This
fact-is explained by the following, viz. that scrofula is almost
always a consequence of the long continued non-observance of
the laws of hygiene. The hygienic ought therefore precede the
pharmaceutical treatment, not only because it often effects a
cure itself, but also, as in the cases in which it does not entirely
succeed, it advances the cure, whereas when neglected, all cure
is impossible.
In the children’s hospital the food given the patients con- |
sists of wine, bread, soup, and vegetables of good quality ; and
Dr. Hager’s Considerations on Serofula. 355
every day, at least at one meal, meat, with all due regard, at the
same time, to the age, appetite, and state of the digestive organs,
The greatest cleanliness is observed. Baths and dry linen are
abundantly supplied. Exercise in open air is eminently useful
in scrofula. It affords the double advantage of quickening the
circulation and improving the state of the functions, more par-
ticularly digestion. Were I not in possession of facts in favour
of exercise, I would have enough to induce me to recommend
it, in the authorities of Baume, who considers rest as fatal in
this affection, and advises almost perpetual motion ; and David,
who assures having cured many patients affected with tumours
in the neck, head, and fingers, by exercise alone. The -ana-
lysis of many observations has convinced me, that scrofula will
be inevitably aggravated, notwithstanding the punctuality with
which the means just mentioned be executed, if the patient’s
dwelling be not exposed. to the direct rays of the sun, and that
it occupies a sombre, low, and narrow situation, where the atmos-
phere cannot be easily renewed. It is not necessary that the
situation and dwelling be both unwholesome to bring on sero-
fula, one or the other being so is quite enough to determine
this affection. It is impossible not to insist forcibly on these
last points, when aware that what favours the development of
the disease, is necessarily opposed to the means of cure. I have
remarked that when the children were obliged, in consequence
of rain, to remain all day in their wards, ophthalmia made its
appearance, and cases that already existed became: evidently
worse with this change in the weather. Having thus spoken of
the hygienic treatment, I will now advert to the medi¢inal
agents. The long continued use of bitters, mercurials, anti-
scorbutics, sulphureous baths, &c. &c., having produced no be-
neficial results, we therefore determined on m aking a choice from
amongst the medicines so much spoken of in the cure of this
disease. The first of these is iodine, a substance recently employ-
ed and to which the most wonderful cures have been ascribed.
The second the ammoniacal hydrochlorate of copper, known by
356 Dr. Eager’s Considerations on Scrofula.
the name of liqueur de Koechlin. Animal charcoal has also been
tried in some glandular swellings, as likewise sulphuret of mer-
eury combined with hemlock and magnesia, subcarbonate of
potass, in fine, the muriate of baryta. The greater part of these
medicines, from their uncertain effects, if not totally abandoned,
are very little employed. My observations in this paper have
for object, the effects of iodine, as being the medicine most fre-
quently used. The extraordmary cures effected by it at the
hospital of St. Louis, induced us to try its action on several
children at a time.
The use of iodine requires the greatest prudence. It has
been administered internally both m a simple form and combin-
ed with iron, mercury, and potass, in the form of pill or in
solution. Externally combined with lead under the form of
ointment, or dissolved in water in its simple state, either in
lotion, injection, or bath. All these means have had their re-
spective advantages. ‘They were consequently used on various
occasions. Iodine taken internally constitutes the basis of the
treatment where the stomach is not affected. The results of
cutaneous absorption are too doubtful to admit of frictions as
the principal form of administering iodine. Children take pills
with much difficulty. Pure iodine may be given in the form of
tincture diluted with water. ‘Two reasons, however, prevent us
from using the tincture at this hospital. In the first place the
fear of mistakes in dropping, mistakes the more easily made
when there are many children under treatment ; and secondly,
our apprehensions lest the water of Arcueil (which is used ex-
clusively in this establishment, and which contains a large quan-
tity of calcareous salts,) may alter the nature of this medicine.
The same objection holds good with regard to the «ethereal
tincture of iodine, the simple or ioduretted solution of hydriodate
of potass, and the alcoholic ethereal tincture of ioduret of mer-
cury. We use the solution of iodine in distilled water called
by Lugol, “ Eau minerale iodée.” Each pint of water contains
two grains of iodine and four grains of hydriodate of potass, the
Dr. Eager’s Considerations on Scrofula. 357
latter being added to render the former more soluble. We
have not deemed it prudent to adopt the use of the solutions of
different degrees of strength which Lugol employs; because in
the treatment of children, particularly when they are numerous,
these different proportions offer many inconveniences without
any real advantage. It is much more simple to administer a
solution that contains a fixed quantity of iodine, which may be
_ prescribed at will in more or less large doses, than to have for
each patient solutions that contain a variable quantity of iodine.
The dose varies with the age, the state of the digestive
canal, its influence on the disease, always beginning with three
ounces of the solution, which may be gradually augmented to
twelve ounces in the day. This is the strongest dose we have
given, viz. Zvi. in the morning and Zvi. in the evening. Hach
ounce contains the 4 of a grain of iodine and j of a grain of
hydriodate of potass. -In following this method we know the
exact quantity prescribed. After the use of this proportion for
some time, we thought to double the quantity of iodine for each
pint, but were soon obliged to abandon it in consequence of the
disagreeable taste of the medicine, and a sensation of heat which
- it occasioned in the throat.’ The solution may be sweetened
immediately before use with sirup of gum. If mixed with this
sirup long before hand, the iodine becomes decomposed, and
the solution loses both its colour and taste. ‘ In order to pre-
serve it long fit for use, it should be kept in bottles well corked
and opened as seldom as possible. The smallest dose to begin
with is Zi. morning and evening, which may be increased to
Zvi. each time as before mentioned. This dose is even stronger
than that Lugol recommends for adults. When no accidents
occur to contra-indicate its use, we continue this solution during
four or five weeks, then we stop it, and give a purge of sulphate
of soda or magnesia. The purgative is repeated two or three
times before we return to the use of the solution. ‘The suspen-
sion continues generally fifteen or twenty days. We then re-
sume, and continue its use a month, then stop it again to give
VOL. V. NO. 15. 3A
358 Dr. Eager’s Considerations on Scrofula.
the purgative as before said. It sometimes happens that acute
accidental diseases oblige us to discontinue the treatment for
some time. Diarrhoea and emaciation, which have been so much
dreaded, seldom occur; when they do, they always cease on
stopping the medicine. I have seen but one case in which the
patient became thin ; all the other children, on the contrary,
have become very fat. The appetite has increased, and their
soft flesh become hard and coloured. I have seen a case in
which the use of iodine was followed by cardialgia, and this
affection ceased on using 3i. of bark once a day, without dis-
continuing the iodine; and after a short time we were able to
give the medicine alone. It sometimes happens, though seldom,
that the use of iodine ulcerates the mouth and affects the breath
as in mercurial salivations. In some females symptoms of cere-
bral congestion appears, such as epistaxis, which yielded to ra-
tional treatment. It is remarkable that these symptoms mani-
fested themselves at the period of puberty, and consequently
may be ascribed more rationally to a deviation of the menstrual
flux, than to any other cause. Messrs. Gardner and Coindet at-
tribute to a kind of iodine saturation, accidents which have been
remarked, in some patients, such as fevers, palpitation, dry
cough, tremblings, loss of strength, and swelling of the legs.
At the Children’s Hospital we have not remarked such cases.
This may be owing to the precaution we use of purging the
children from time to time. Moreover, these symptoms are ex-
tremely frequent in the third stage of phthisis in patients who
never used iodine. The ioduret of iron may be given with good
effect in this affection, more particularly in cases where the pa-
tients are very pale,’and their flesh soft and flabby. This medi-
cine may be given in larger doses than the hydriodate of potass.
We begin by half a grain in Zi. of water morning and even-
ing, and increase it half'a grain every four days. It may be
increased to ten grains a day ; in higher doses it induces vomit-
ing. The solution of ioduret of iron produces diarrhoea much
more frequently than the iodine solution. Iodine frictions are
Dr. Eager’s Considerations on Scrofula. 359
very useful auxiliaries to its action internally, We rub the tu-
mours with an ointment composed either of ioduret of lead,
ioduret of mercury, or ioduret of potassium. It sometimes hap-
pens, (as with other medicines in all diseases,) that the oint-
ment first used brings the tumour to a certain degree of dimi-
nution, and then it remains stationary. In such cases it is use-
ful to substitute one of the others, and by this means the absor-
bent system is kept in a state of salutary excitement. The oint-
ment of ioduret of mercury is composed of 31. axunge, and 3ss.
of ioduret of mercury, that of lead of 3i. to Zi. of axunge, and
that of ointment of hydriodate of potass with iodine, of 3i.
hydriodate and twelve grains of pure iodine to each ounce of
axunge. The ointments of ioduret of mercury and potass de-
termine a pricking pain that continues fifteen minutes, that of
lead does not produce this sensation although applied to ulcers,
spread on linen or charpie. A child ought to be rubbed but
once a day, and an adult twice, in consequence of the skin being
less irritable, and absorption less active in the latter; each
friction during five or six minutes; and the quantity of the oint-
ment varies with the size of the tumour, the minimum being
that of a small pear or nut. We have in no case relied on fric-
tions as the sole means of cure. They have always been com-
bined. with iodine internally and in baths. It is a matter of per-
fect indifference to which of the ointments you give a prefer-
ence. For injecting fistulous trajets we use a solution of twelve
grains iodine and twenty-four hydriodate of potass in one pint of
water.
Caustic iodine, (made by dissolving equal parts of iodine
and ioduret of potassium in a quantity of water equal to the
other two substances united,) when applied to the skin, deter-
mines a good deal of smarting, and when it is put on ulcerated
surfaces three times a week, it acts as a desicative.. To a bath
that contains 300 litres of water, we put Ziiss. of iodine and 3v.
of ioduret of potassium, dissolved previously in Tbii. of rain
water, and to one that contains 260 litres, 3ii. of iodine, and ziv.
360 Dr. Eager’s Considerations on Scrofula.
of ioduret of potassium. Many children may be put into one of
these baths together; it matters not what form of the disease
they present. Some patients, during and after the bath, feel
pain on the ulcerated surfaces, and in some instances a painful
redness of the skin comes on. This redness may be owing to
the high temperature of the water, a circumstance which in-
creases the action of iodine. These trifling accidents seldom
occur, and are very trifling in their effects. The bath almost
always produces an abundant diaphoresis, followed by sleep,
and the ulcers present for several hours avery strong tendency
to cicatrize, and assume an appearance similar to that brought
on by the use of chloride of lime as a topic when applied to
burns ; nevertheless, the purulent discharge, although less abun-
dant, re-appears after a short time. ‘The smell of iodine has a
salutary influence on the air of the wards. It is remarkable that
sulphureous baths have never produced a similar effect. We
leave the patients in the bath as long as transpiration is not ex-
ireme, and their faces not much injected. When the tincture
is used, six ounces of it are to be added to 300 litres of water ;
this quantity is equivalent to 3ili. of iodine. It is first mixed
with thiiss. of water, and then added to the bath. No precipi-
tate takes place, and it produces the same effect as the other
preparations.
Sixty-seven female children have been treated with iodine
for a period sufficiently long to enable us to determine its effects
with precision. ‘Their age varied from four to fifteen years, a
little more than half were over ten years old. In all of them
the disease was of long standing; one was in the hospital since
1822, two since 1826, six since 1828, ten since 1829, twenty-
six since 1830, and thirty-two were admitted since 1831, either
before or after the Ist April, at which period the treatment
commenced. In all these children the disease presented itself
under different forms. Fifteen of the sixty-seven who were
treated by iodine were discharged cured of the apparent symp-
toms of the disease ; fourteen experienced considerable amend-
r
Dr. Eager’s Considerations on Scrofula. 361
ment, which announced a speedily approaching cure. In thir-
teen others, although the improvement was less evident, one
could judge that the cure would take place at some not far dis-
tant period ; five received but little benefit from it, and, in fine,
twenty did not receive the slightest advantage from the use of
this medicine. Among the children cured was one admitted in
1826, two in 1829, seven in 1830, and five in 1831. Among
those who experienced considerable benefit, was one admitted
in 1826, two in 1828, three in 1829, five in 1830, and three in
1831. Of the twenty who were not at all relieved, two were in
hospital smce 1828, four since 1829, seven since 1830, and the
remaining seven since 1831. All these children, with a few
solitary exceptions, were much more affected at the period they
commenced the use of iodine than at the time of their admis-
sion. The disease had increased with their sojourn of many
months, and even years, in the wards.
I have entered into all this detail to satisfy those who are of
opinion that this affection has a determinate existence, and that
after a certain time we obtain a cure, no matter what medicines
we use. Now, in analyzing those facts, it becomes evident that
if two patients admitted in 1826 were cured, another admitted
in 1822 scarcely experienced any benefit. In comparing the
numbers, we also find that the old date of the affection ought to
be considered as having little fluence in bringing about the
marked improvement or speedy cures that were obtained.
Seventeen of the sixty-seven submitted to this treatment had
glandular swellings. In only four of these, the tumours en-
tirely disappeared. Iodine was used in bath, friction, and solu-
tion given internally. In one case, the treatment reduced a
very large tumour to three small ones in a very short time ;
these small ones remained stationary. How are we to explain this
obstinacy, this resistance to the action of a medicine which dis-
sipated, and that so rapidly, the nineteen-twentieths of this
swelling? The following is probably the reason: ‘These tu-
mours constitute the nucleus of the affection; they are at first
362 Dr. Eager’s Considerations on Serofula.
isolated and distinct, and by their presence inflame the cellular
tissue which surrounds them. This inflammation is followed by
the induration and increase of volume of this tissue, and hence
it is that after a time they all form one compact mass. Now,
iodine, in whatever form it is used, acts specially on the absorb-
ent system, and when rubbed on these tumours, promotes the
resolution at first of the indurated cellular structure, and sub-
sequently of the enlarged glands, if these glands be but simply
enlarged. Thus in some such cases the tumours entirely dis-
appear ; but if, instead of being simply indurated, these glands
contain tubercular matter in their substance, as this matter does
not appear susceptible of resorption, the absorbent vessels,
whose action has been increased by the medicine just men-
tioned, produce no action on them. These tubercles remain
after the simple glandular and cellular indurations have disap-
peared, until an irritation ensues, (induced either by their pre-
sence in a structure abundantly provided with nerves and blood-
vessels, or probably by the irritating applications which have
been used with a view to bring on resolution), and this irrita-
tion is followed by phlegmonous inflammation, abscess, ulcera-
tion, and finally, by the elimination of the tubercular matter,
which was a component part of these tumours.
Three children were cured of small tumours on the neck.
In thirteen cases the iodine completely failed, inasmuch as that
the tumours either did not diminish, or that inflammation came
on, followed by abscess. Many tumours terminated in this
way, whether it was that the iodine produced this effect on
them, or could not prevent this termination. Of sixteen chil-
dren affected with tumours which terminated in abscess, with
whom we used iodine, only eight were cured. In the treat-
ment of the ulcers subsequent to these abscesses, to the other
means of cure we added injections of iodine solutions into the
purulent sinuses. The ulcerated surfaces were covered with
pledgets of lint with ointment of ioduret of lead, or imbibed
with a solution of iodine. In eight children there was no
Dr. Eager’s Considerations on Scrofula. 363
amendment produced after many months’ treatment; in eight
others a complete cure of the swelling was obtained. In some
cases of ulceration, notwithstanding the absence of all swelling,
the most methodical dressings, injections, and well applied pres-
sure, the skin will not adhere to the subjacent tissue. In order
to obtain a perfect cure in such cases, it is necessary to lay bare
all the ulcerated surface by destroying the loose skin until you
arrive at the neighbouring healthy skin, either with a caustic
application or the cutting instrument. The sore then heals ra-
pidly, and in no case has the cicatrix presented that thickness,
irregularity, and deformity, so frequent when the ulcer is left
to nature, and which are the “ unequivocal” marks of a disease
which patients would often wish to conceal.
In serofulous ulcers the skin is so bare and thinned that it
cicatrizes with the greatest difficulty, and although the bottom
of the sinuses be long since deterged and disposed to unite with
the skin, the union does not take place, the skin not being in
the condition indispensable to such a change. After many use-
less efforts to unite the parietes of these sinuses, nature cicatrizes
them separately.
Now, if we bear in mind the mechanism of the formation of
cicatrices, the dragging the surrounding parts experience from
the flattening (afaissement) and contraction of the granulations,
we will easily understand how the skin shrivels, doubles on it-
self, and at the same time presses forcibly against the cicatrix
which covers the bottom of the sinus. In this case, there ex-
ist two cicatrices superimposed. When the cicatrization, in-
stead of commencing at the bottom of the sinus, first takes place
on the skin, the skin doubling on itself and contracting as in
the former case, presses firmly against the ulcerated surface,
vegetations arise around it, surpass its level, and when they be-
gin to heal, enchase it, as it were, constituting these cleva-
tions or scrofulous cicatrices which the French call « brides.”
The skin ought never be removed until the glandular swel-
ling has disappeared, otherwise it will be necessary to repeat
364 Dr. Eager’s Considerations on Scrofula.
the operation. Even when the “ engorgement” has ceased to
exist, before having recourse to either caustic or bistoury in or-
der to remove the skin, stimulating injections and pressure may
be tried, and the probability of success from these means con-
siderably increases if the skin has preserved a certain degree of
thickness, and that its colour does not differ from that of the
surrounding parts. Although such attempts are sometimes
fruitless, they are not to be overlooked, especially when the ul-
cer occupies a part of the body which is constantly exposed to
view, and where consequently it is necessary to obtain a cicatrix
that will present the least possible extent. When no good re-
sults follow these remedies after ten days’ use, it will then be ne-
cessary to have recourse to the caustic or cutting mstrument.
The destruction of the skin in this way offers the double ad-
vantage of a rapid cure and an undeformed cicatrix.
When left to nature, these ulcers take many months, and
even years, to heal ; and even then the cicatrix will be deform-
ed, large, and characteristic. On the contrary, when art inter-
feres, the cure is obtained in fifteen days or a month at farthest.
The cicatrix is smooth, and differs in no manner from that
which follows a simple wound with loss of substance. When
it is deemed necessary to destroy the skin, the operation ought
to extend to the limits of the décollement. As I have before
said, we use indifferently the caustic or bistoury. The follow-
ing is the caustic preparation which I have frequently applied
with success: Powdered quick lime, six drachms ; caustic po-
tass, five drachms: powder the potass in an iron mortar, add-
ing gradually the lime. This gives a fine powder, which 1s to
be kept in a bottle hermetically closed. When about to use
this caustic, make a paste of the powder with spirit of wine,
and apply it in a layer of about two lines thickness on the part
which it is intended to cauterize. The eschar will be of the
exact extent and thickness of the layer applied, and in six mi-
nutes the skin is cauterized to the subjacent cellular tissue.
Dr. Eager’s Considerations on Scrofula. 365
The paste is then removed, unless it be intended to produce a
more profound eschar.
These considerations on the cicatrization and local treatment
of scrofulous ulcers are quite independent of the general treat-
ment. They are applicable to those ulcers, no matter what
other treatment is used. |
It appears to me, from this exposé of the effects of iodine,
that we are not to consider the results obtained as merely at-
tributable to a fortuitous coincidence of the administration of
this remedy with the cure of the disease, but rather the action
of one en the other.
In three cases of periostosis a rapid cure has attested the
eflicacy of iodine. The diseases of the bone yield less speedily
than those of the soft parts, owing to the slowness with which
the vital functions go on in them. Lesions of these parts fre-
quently occur in scrofula under the form of swellings, a re-
gular hypertrophy of this tissue. Caries is also very frequent:
Necrosis is not rare in scrofula, although some authors hold a
contrary opinion. Swellings of the articular extremities are also
frequent, swellings which render the motions of these articula-
tions extremely difficult, thereby constituting false anchylosis.
These swellings are accompanied by inflammation of the sur-
rounding cellular tissue and abscesses, followed by numerous
fistulous trajets. Masses of tubercles are often found round
the joints, and these tubercles give rise to abscesses and ulcers.
In thirty cases of caries I have seen but four cures; twelve
experienced considerable improvement. ‘This proves that io-
dine is not less effectual in the treatment of this form of the
disease, (taking into account the organization of bones), having
produced a beneficial effect on nearly half the cases subjected
to its use. Necrosis of the bones of the tarsus and metacarpus,
of the phalanges of the fingers and toes, is not rare in scro-
fula, and iodine in such cases-stops the caries and diminishes
considerably the suppuration. In order to obtain this end,
VOL. v. NO. 15. | 3B
366 Dr. Eager’s Considerations on Scrofula.
abundant injections and the use of iodine by the mouth are ne-
cessary.
When the new bone is large, after the sequestrum has been
removed, its size may be diminished by moderate pressure by
means. of strips of adhesive plaster tightly rolled round it.
Esthiomena (lupus) is one of the forms of scrofula which does
not yield to iodine in anyform. I know of two cures obtained by
the exhibition of arseniate of soda internally, and as an external
application, an ointment composed of orpiment, quick lime, and
caustic potass. As a caustic, this ointment may be applied toa
surface as large as a shilling without danger. I have given
three-fourths of a grain of arseniate of soda to children, begin-
ning with the one-sixteenth of a grain, as a dose, but not more,
without inconvenience. In scrofulous ophthalmia (as in many
other chronic diseases) the last remedy applied often appears
to be that which has produced most benefit, whereas it fre-
quently has no other merit than that of being administered
when nature was about to effect a cure. Thus, ophthalmia often
comes on without any assignable cause, and disappears in like
manner. ‘The transition from dry to cold and moist weather
renders this ophthalmia most frequent. This I have remarked
at the children’s hospital. When, on the contrary, we haye a
continuance of dry weather, the disease disappears under the
influence of medicines that were hitherto utterly ineffectual.
When this ophthalmia assumes an inflammatory character, local
and general bleedings are useful. The intensity of the disease
is diminished, but the cure is seldom effected by these means
alone. It persists ina chronic form for an indefinite period in
spite of the most rational treatment. ‘The same is observed in
originally chronic scrofulous ophthalmia. Emetics, purga-
tives often repeated, blisters, setons, collyria of all kinds, may
completely fail, and the disease disappear in a few days spon-
taneously, a little after all curative means had been suspended.
When this disease attacks the ocular conjunctiva, Sydenham’s
Jaudanum dropped in alternately, with some few grains of calo-
Dr, Maunsell’s Report. 367
‘mel blown into the eyes, the one in the morning and the other
in the evening, have been more useful than any other remedy.
When the borders of the eye-lids are red and swollen, and that
the glands of Meibomius secrete a purulent liquid which dries
on the lids, the ointment of red oxide of mercury diluted is an
excellent application. It is composed of 3ss. of red oxide,
and i. of unguentum rosat. a little to be rubbed to the lids at
night. Iodine is of little or no benefit in the treatment of these
‘ophthalmias. ‘Staphyloma and considerable deformity of the
_ eyes, ulcers of the cornea, are frequent consequences of these
ophthalmias ; specks on the cornea, and even ulcerations, when
superficial, of this membrane, have been cured by the use. of
calomel and laudanum applications. Purulent discharges from
the ears, nose, and vulva are frequent in scrofula, and in such
cases iodine injections may be used frequently in the day with
the best effect. | :
In fine, it may be inferred from all these facts, that without
ascribing to iodine, in the treatment of scrofula, specific pro-
perties of a decided ‘nature, such as those exerted by bark in
ague, we must nevertheless admit that no other remedy hither-
to used in scrofula is so often or so generally successful as. io-
dine.
Art. XXI.—Report of the Obstetric Practice of the Welles-
ley Female Institution during the Year 1833. By Henry
Maunsett, M.D., Accoucheur to the Institution, Assistant
Physician to the Magdalen Asylum and to the Institution
for Diseases of Children, and Lecturer on Midwifery, &c.
at the Medical School, Park-street, Dublin.
In the present report [I shall pursue the same plan as was
adopted in that for the year 1832, (published in the Edinburgh
Med. and Surg. Journal, No. 117), stating in the first place the
statistical facts which we were able to observe, and, secondly,
368 Dr. Maunsell’s Report
giving brief abstracts of any thing remarkable in practice which
eame within our notice.
The total number of cases attended from the Ist January,
1833, to the Ist January, 1834, amounted to 428. Of these,
twelve were abortions, leaving a balance of 416 labours. From
these were produced 421 children, there having been five cases
of twins, or one in 831. The proportion of the sexes among
the children was 256 males and 165 females, a very remarka-
ble difference, and the more so, that in the births ocecurrmg in
the institution during the year 1832 (and noticed in the last re-
port) the males were to the females as 211 to 220. The num-
ber of dead born children amounted to thirty-five, or one in
twelve, of which twenty-four were male, and eleven female,
many being, as in the former year, premature.
The ages of the 428 women attended were as follows :—
Under 20 years, 24 women.
Between 20 and 25, 124
25 and 30, 164 3
30 and 35, 58
35 and 45, 57 ————
Of 47 years, 1
The duration of labour in the 416 labour cases was accord-
ing to the following table :—
Of 6 hours and under, 147 cases.
Between 6 and 12 hours, 154
12 and 18 ; 52
18 and 24 ——, 30
} 24 and 48 ——, 21
PREV EE
Of 56 hours, 3
64 en 3
72 —_, 1
In the 411 cases of single births, the presentations were—
Natural . . . 399, including 5 of the face and 1 with
the face towards the pubis.
of the Wellesley Female Institution. 369
Of the breech ... . . «.-».--6
ICEL TA AY. 2 caa date AG
Nei ie a ce ad
Total of the lower extremities 13, or } in 31.8.
Ol the-ppet ic. 4. ducat. O
Piteentacs) fsck sree oa -OF diane ba7.
3 NIB dae cnactie cat Sade bein: Al b.
In the five twin cases the presentations were natural in two
cases. First child, of the lower extremities ; and second, na-
tural in one case.
Both of the lower extremities in two cases.
The sexes in these were—
_In 3 cases both females.
males.
In I case
In 1°
The perforator was employed four times, but as one of the
operations was for the liberation of the head of a dead child in
a breech presentation, I shall take three as the number ne-
cessarily performed, which gives an average of 1 in 137 cases.
The forceps was attempted to be used in one case (a face
presentation) but failed, and the perforator had ultimately to be
one of each.
resorted to.
In three cases, or 1 in 137, there was severe hemorrhage
after the birth of the child ; all terminated favourably.
In two cases, or 1 in 2053, the placenta was retained, with-
out hemorrhage, and required manual extraction.
There were three cases of convulsions ; 1 in 157.
Of the whole number of 428 women entered upon the books,
44, or nearly 1 in 10, are marked as having had previous abor-
tions.
Crotchet Cases.—In three of these eases the women reco-
vered perfectly without a bad symptom. In one (as has been
already noticed) perforation was employed merely for the pur-
370 ‘Dr. Maunsell’s Report
pose of facilitating the passage of the head of a dead child,
which had presented with the breech. In the second case (a
first labour) the woman was sixty-four hours ill, all uterine ac-
tion had ceased, and from the condition of the scalp and over-
lapping of the bones of the head, it was manifest that the child
had been for some time dead. ‘The operation was easily ac-
complished, and the woman recovered very well.
The third case was one of face presentation, the child being
very large. The labour was not interfered with during thirty-
four hours, at the termination of which period the pains became
very weak and quite ineffectual ; the soft parts were beginning
to suffer, the right labium being swoln, and the epidermis, on
its inner side, raised into a blister. The upper part of the
neck, chin, and mouth of the child presented, and together with
the tongue, which protruded between the lips, were livid and
exceedingly swoln. No advance had been made for several
hours, but during the last effective pains there appeared to be
a tendency to force down the neck of the child anteriorly, and
to press the forehead backwards, out of reach of the finger, into
the hollow of the sacrum. Under these circumstances, as the
woman had had four children, and there appeared to be no re-
markable want of room, it was determined to attempt delivery
by the forceps. Only one blade, however, could be fairly in-
troduced, which was passed between the head and sacrum,
and used as a vectis for more than an hour without the slightest
effect. As the woman was now getting considerably weaker,
and the pains had entirely ceased, she was delivered by the
crotchet, the perforator being introduced through the orbit.
Very considerable force was required, even after the brain had
been completely evacuated. ‘The woman was threatened with
peritonitis, but ultimately recovered. The fourth crotchet case
terminated unfavourably. The patient was 25 years old, and in
labour of her first child. When she was visited from the insti-
tution she had been under the care of a midwife for several
hours, the pains were found to be very strong and violent, and
of the Wellesley Female Institution. 371
the head firmly wedged into, the brim of the pelvis, with a por-
tion of the anterior lip of the os uteri caught between it and
the symphysis pubis. The woman was flushed and restless,
pulse 120, strong and full, and her bowels had been confined
for several days. There was no abdominal tendency, and she had
made water freely ; but her countenance expressed a peculiar.
anxiety, which, coupled with the obstinate costiveness, alarmed
me with respect to her from the first moment I saw her. A
bolus of calomel and jalap was administered, followed in a short
time by an enema, and Zxvill. of blood were taken from her
arm. This was at 11 o’clock on Sunday evening (Dec. 9).
Some effect was produced by the purgative, and the extreme
violence of the pains was a little diminished. At 8, A.M. on
Monday, the presentation was exactly in the same state, the
pains continuing regular and strong, although not so violent as
on the preceding night ; the pulse 120 and strong ; tongue soft
and clean; countenance still anxious. A catheter was intro-
duced, and some brownish urine drawn off. At 1, p.m., mat-
ters were precisely in the same state ; the foetal heart could be
plainly distinguished with the stethoscope. At 3, p. m., there
was no change in the symptoms or position of the head, but
as the pains had become weaker and the pulse 140, and seventy-
two hours had elapsed from the beginning of labour, it was de-
termined to deliver her. There was considerable deficiency of
room, but the head, being well emptied, was extracted without
any violence to the soft parts. The placenta was expelled na-
turally in a few minutes, and shortly afterwards the woman was
seized with a rigor which lasted twenty minutes. Ten grains
of Dover’s powder, and two of calomel, were given at bed
time. On the next day (Tuesday) there was some slight ten-
derness over the uterus; the pulse were 130, and the coun-
tenance anxious, but there had been no return of rigor, and the
tongue was clean and moist: a grain of calomel and a third of
a grain of opium was given every fourth hour. In the evening
the abdomen was stuped with turpentine, Zxii. of blood ab-
372 Dr. Maunsell’s Report
stracted, and the calomel and Dover’s powder given as on the —
preceding evening. From this period forward the abdomen
remained soft without the slightest tenderness, except the uterus
itself was very firmly grasped; there was no return of rigor,
and the tongue continued perfectly clean and natural. The
pulse, however, never fell below 130, and the countenance still
retained the peculiar anxious look which had attracted our no-
tice from the beginning. On the third day after delivery, a
feculent diarrhoea set in, for which enemata of starch and
laudanum were administered without any effect. It was now
determined to endeavour to salivate her quickly, and four grains
of calomel and one of opium were given every four hours; the
first effect of which was to check the diarrhoea and procure
sleep. In this way upwards of a drachm of calomel was given
without in the slightest degree affecting the mouth. The
symptoms remained precisely as last stated, the woman oradu-
ally getting weaker. On the tenth day the feculent diarrhoea
returned, and on the twelfth, without any aggravation of symp-
toms, her stomach became sick, she vomited a little, and imme-
diately expired. ‘There was no lochial or other discharge from
the vagina after the second day, and the urine was freely evacu-
ated.. Was this a case of inflammation of the uterine sub-
stance? Unfortunately no post mortem examination could be
obtained.
The presentations of the lower extremities all went on fa-
vourably as far as regarded the mother. They were nearly
twice as numerous as in the year 1832, while, on the other
hand, there were this year no presentations of the upper ex-
tremities. |
In the cases of placenta presentation the mothers’ lives
were all saved. In two, turning was performed. In all three,
the children were dead. In one of the cases in which turning
was resorted to, the plug was employed with marked advantage.
The woman was in the beginning of the eighth month of preg-
nancy, without the slightest appearance of labour, and with an
undilated os uteri. She had been losing blood occasionally
of the Wellesley Female Institution. 373
for several weeks, when, on the 3rd April, at 3, p.m., a larger
gush than usual having occurred, a plug saturated with vinegar
was introduced fully into the vagina. This restrained the he-
morrhage until 7 o’clock, when pains came on, and the plug
was expelled, followed by a violent discharge, upon which the
hand was immediately introduced, and delivery effected. In
the case in which turning was not performed, the woman, zetat.
40, at the full period of pregnancy, was seized with hemor-
rhage on the 6th of May, which continued occasionally until the
8th, when she sent to the institution. The pupil who visited
her found her with a bleached countenance, very feeble pulse,
cold extremities, and a smart draining of blood from the vagina.
He immediately introduced a plug, and sent for me. On ex-
amination, the placenta was found within half a finger’s length of
the external orifice, completely blocking up the vagina. It appear-
ed to have passed completely through the os uteri, which could
not be felt. There was now no bleeding whatsoever, although
the woman had regular, pains. Upon prosecuting the examina-
tion at the anterior part of the vagina, for the purpose of ascer-
taining what was beyond the placenta, the membranes were
ruptured, and the head felt. The pains continued regularly,
though weakly, until the placenta could be seen protruding
through the vulva. By degrees the head was forced under the
arch of the pubis, and in proportion as it gradually advanced,
the placenta was pressed backwards and upwards into the hol-
low of the sacrum, until the head filling up the whole vulva the
other could no longer be felt. A dead child was naturally ex-
pelled, and the placenta found loose in the vagina. It was flat-
tened as if it had been subjected to considerable pressure.
In two of the cases of hemorrhage the placenta was extract-
ed. In the third the hemorrhage was caused by the patient
standing up in an hour and a half after a complete but very
sudden delivery. It produced very alarming fainting fits, but
was effectually restrained by external pressure.
Convulsions.—In one case (seen by Dr. Churchill) the con-
VOL. V. NO. 15. 3¢
374 Dr. Maunsell’s Report
-vulsions came on at the full period of pregnancy. “The woman
was at first sensible between the paroxysms, and complained of
headach, with a quick strong pulse. She was bled twice to
the amount of 3xxvi., her head shaved, and cold applied to it,
and the membranes were ruptured. In a few hours she was de-
livered of a dead child. The fits, however, still continued
every half hour until the next day, when a blister was applied
to the nape of the neck, and 3xx. of blood taken from the tem-
poral artery. Purgatives were also given, and subsequently
enemata, with tincture of opium and assafcetida. She perfectly
recovered, but without the slightest recollection of any circum-
stance connected with her illness.
In the second case the woman had a natural (first) labour of
twelve hours’ duration. During her pregnancy she had suffered
very much from cedema of the lower extremities, which prevent-
ed her from taking exercise. In seven hours after her delivery
of a healthy child, she was seized with violent convulsions,
which recurred very frequently, leaving her in the intervals per-
fectly insensible, with a quick full pulse, (about 150), and pale,
leuco-phlegmatic face. She was bled to Zxvi., a bolus of calomel
and jalap laid upon her tongue, a turpentine enema administered,
and her head shaved and kept cool. The fits continued, but
at. longer intervals, during the day and night. In the evening a
blister was applied to the head, the enema repeated, and the
abdomen stuped with turpentine. The bowels were opened,
after which she had but one fit. On the following morning she
lay in a drowsy state, but could be roused to answer questions,
and eagerly took drink. She from this time gradually improv-
ed and recovered well, but without retaining the slightest recol-
lection of her labour, or of any event which had occurred dur-
ing three or four days previously, although she was then ap-
parently free from all affection of the head.
The third case was a fatal, one. The woman was about
40, strong looking, with a thick short neck, and leuco-phlegma-
tic face. She was in the sixth month of her seventh pregnancy;
of the Wellesley Female Institution. 375
and had been prematurely delivered (at the same period of ges-
tation) of all her children except the first. We heard that she
had had convulsions in her last labour but one. At 3, a.m,
December 10, she was seized with pain and tenderness in the
epigastrium, restlessness, and retching. Her pulse were quick
and hard, tongue white, but no headach. Dr. G. Thorpe, who
was then a pupil of the institution, saw her immediately, and
took from a large orifice Zxv. of blood. Warm stupes were
applied to the abdomen, which relieved her for a short time,
but at half past six she was seized with fits, which recurred every
half hour without any interval of sensibility. At 10 o’clock
she was again bled to 2x., a turpentine enema administered,
her head shaved and kept cool, and a bolus of calomel and:
jalap placed upon her tongue. At 11, successive doses of a
solution of tartarized antimony were poured into her mouth,
which produced vomiting. At 3, pr. m., the paroxysms had be-
come more frequent, the pulse were very quick and irregular,
the pupils insensible, one being dilated and the other contract-
ed, the breathing stertorous ; she was again bled to 3x. At
4 there was no amelioration; the membranes were ruptured,
and a blister applied to her head. At 9, p.m, a female foetus:
was expelled during a convulsion. After this she had only
three paroxysms, but she remained quite insensible, and had no
evacuation from the bowels. At 3 on the following day (thirty-
six hours after the first attack) she expired. No entreaties:
could prevail upon her friends to allow of a post mortem ex-
amination. |
Imperforate Rectum.—An instance of this malformation
was met with during the year. The child (a female) was ap-
parently well formed, the anus being open and perfect. It had
no evacuation after birth, notwithstanding the administration of
a spoonful of castor oil. On the second day the abdomen be-
gan to swell, the child vomited meconium, and had two or three
fits of convulsions. Some attempts at throwing up enemata hay-
ing failed, I was sent for, and upon introducing a gum elastic
376 Dr. Maunsell’s Report
catheter, found that the rectum was completely closed at the
distance of one inch from the anus, forming a perfect euwl de
sac. An operation was recommended, but from the unwilling-
ness of the friends, was not performed until the fourth morning
after birth. I then opened the anus with a dressing forceps,
and passed up a probe in the presumed direction of the gut.
When it had gone about an inch beyond the obstruction, a lit-
tle air was observed to escape; it was then withdrawn, and a
director introduced, along which a trocar was pushed; the
canula was allowed to remain in the passage, and through it a
large quantity of meconium immediately passed, and continued
passing for several hours. The child lived two days, the gut
remaining pervious, but ultimately died in a fit.
Only two deaths of mothers are recorded during the year,
both of which have been already noticed. ©
Before concluding this report, I am anxious to make a few
remarks which, no doubt, must be very imperfeet, but which
are put forward now as the subject is fresh im my mind, and an
opportunity for noticing it may not again occur. I wish to offer
to the profession a friendly caution against the édiserimi-
nate and inordinate employment of ergot of rye, and in doing
so, desire to be understood as in no way retracting the fa-
vourable opinion of its prudent use expressed in my former re-
port. What I mean to say at present, is, that extraordinary doses
of this drug occasionally produce dangerous effects upon the
nervous system, and probably other mischief, and at the same
time are less likely to act upon the uterus than smaller quan-
tities.
Mary Redmond, in the fourth month of pregnancy, was
seized after a fright and severe exercise with hemorrhage from _
the vagina, which continued at intervals for several days. On
the 10th March, 1834, at 6, p.m., Dr. Churchill saw her and
gave forty-five drops of tincture of opium ; at 9, Pp. M., she was
so weak that a plug was introduced. At 7 o’clock on the morn-
ing of the 11th, the plug was expelled with considerable he-
of the Wellesley Female Institution. 377
morrhage, and Dr. Churchill ordered a grain of opium and two
table spoonsful of acid purgative mixture every second hour.
At 8, p.m. of the 11th, hemorrhage set in again, and Dr.
Churchill gave 3ss. of the ergot, and repeated it in half. an
hour. On the 12th, she had violent headach, and in the course
of the day became delirious, and could with difficulty be kept
in bed. These symptoms yielded to purgatives, shaving and
blistering the head, &c. In a few days afterwards the hemor-
rhage returned, ergot was again given, and again followed by
delirium, although in a slighter degree.
Mrs. Forrest, two months pregnant, was attacked with he-
morrhage from the vagina on Thursday, the 21st April, for
which she was kept quiet, cold applied to the vulva, and the
acid purgative mixture given. On Friday the discharge re-
turned in an alarming degree, and the infusion and substance of
38s. of ergot was given to her by Dr. Churchill in two doses,
with an interval of fifteen minutes. After taking it she fell
asleep, and when she awoke the discharge returned ; another
scruple of ergot was then given, in an hour after which she
vomited. On the following day she was in a state of half stu-
por, with very violent headach and weak, depressed pulse.
Her head being shaved, &c., and purgatives administered, these
symptoms gradually gave way.
The occurrence of these two cases attracted my attention to
the subject, and upon inquiring among my friends I found that
they did not stand alone. Part of the information which I re-
ceived, I shall now briefly recite.
A case was related to me by Dr. Johnson, in which labour
of a first child was rendered tedious by the want of uterine
action; as the woman had a well formed pelvis, the head
had passed the os uteri, the soft parts were cool and well dilat-
ed, and there was no fever, it was thought advisable to give the
ergot. Through a mistake of the person in immediate atten-
dance the infusion and substance of two drachms of powdered
ergot was given in two doses. In six hours Dr. J. was again
378 Dr. Maunsell’s Report
called, and found the patient in a state of incomplete coma, with
livid face, and muttering delirium. His first impression was that
she had had a convulsion, but finding her pulse reduced toa
thread, and only seventy in a minute, he was induced (by his
having known similar depression of pulse to follow the admuinis-
tration of ergot) to make further inquiry, and then learned the
mistake respecting the double dose. There was no uterine
action whatever. She was delivered by the forceps, and remain-
ed thirty hours delirious and in a state of partial stupor. She
was afterwards threatened with peritonitis, and had a bad reco-
very. Inanother case in which ergot was used largely, Dr. John-
‘son saw complete gangrene of the external patts and death occur
six days after labour. In a third he witnessed extensive slough-
ing of the vagina, without any other probable cause. In neither
‘of these two cases were any instruments used. Attributing such
results as these latter to the abuse of ergot may appear to be
a mistake of the posé for the propter hoc, but as we know that
gangreneisaconsequence ofits employment as an article offood,*
they should at least make us cautious. The followmg extract
of a note which I had the pleasure of receiving from Dr. 8.
Cusack, contains some interesting statements. He says:—‘ Not
having notes of the cases in which I used the ergot of rye, I
shall briefly state from recollection my experience of it. I was
formerly in the habit of giving the infusion and substance of half a
drachm, and repeating the same dose at intervals of ten minutes.
In one case, supposed at the time to be favourable, the quantity
stated above was given three times; the pulse came down from
120 to 90, considerable stupor and epistaxis supervened, but
no uterine action whatsoever. The patient was ultimately deli-
vered with the crotchet. In a second case the pulse came down
even below the natural standard, a similar tendency to coma ex-
isted, and as no uterine action was excited, the child (an acepha-
* Vide Thomson on Inflammation.
of the Wellesley Female Institution. 379
lous one) was delivered by the forceps. I have since used the
ergot in ten grain doses, and I think with more effect.
<“Your’s, &c.
«S. Cusack.”
« May 1.”
Upon looking over a short essay upon the use of internal
medicines in parturition by Professor Joerg of Leipzig,* which
was sent to me lately by my friend Dr. E.. Joerg, I find the views
referred to above corroborated by the results of experiments
with ergot performed upon the stomachs of the Professor him-
self and several of his pupils as well as upon animals. When
taken in large doses it was always found to produce nausea, and
vomiting, pains in the abdomen and diarrhoea, weight and pain
in the head and vertigo, with general mal aise, and depression.
Upon animals it produced similar effects, and in the smaller
animals, (as doves and cocks,) a comparatively small dose caus-
ed death, which was preceded by coldness and lividity of the
extremities, and often accompanied by convulsions. I cannot,
however, agree with the learned Professor in condemning its
use altogether, nor am I convinced of its inefficacy by the pun
in which he affirms that he can see no relation between mutter=
korn, (ergot,) and gebdr-mutter, (the womb,) except the word
mutter, which is common to both. I shall leave the foregoing
facts to speak for themselves ; they are not sufficient foundation
for a theory, neither is it my wish to erect one upon them ; they
are merely put forward in the hope that they may act as a drag
upon the destructive career into which, I believe, ergot as well
as every other new medicine has been forced. The mantle of
the men of Athens appears to have fallen upon the medical po-
pulace of the present day ; their desire to tell or to hear some
new thing is only matched by their extraordinary credulity. Let
* Dass der Gebrauch innerer Reizmittel zur Beforderung der Geburt des
Kindes unnéthig, fruchtlos und gesunden Frauen sogar schadlich sei ; nachgewie-
sen, &c,
380 ~Dr. Williams’ Letter on Asphyxia.
any man introduce a new instrument with a barbarous name, or
a medicine, as ergot, which can cure amenorrhoea and menorrha-
gia, epistaxis and leucorrhcea, the idol (as Dr. Joerg appro-
priately calls it) will soon have a host of worshippers, and as
it must be to many of these, to all intents and purposes, an un-
known god, the sacrifices made before it are not difficult to be
imagined.
Art. XXII.—Letter from Dr. Witttams on the Subject of
Asphyxia.
TO THE EDITORS OF THE DUBLIN JOURNAL OF MEDICAL AND
CHEMICAL SCIENCE.
Liverpool, May 12th, 1834.
GENTLEMEN,
As the Editors of a distinguished medical pub-
lication, I deem it necessary to address you on a subject that
has not only reference to myself, but in some respect to medical
literature. Presuming it likely, that the work on the Phy-
siology, &c., of Asphyxia, just published, by Dr. Kay of Man-
chester, may be reviewed in your Journal, I am desirous of
putting you in possession of certain circumstances connected
with his subject. I may remark, though familiar to you, that
until lately, Bichat’s views of the nature and cause of asphyxia
were considered the most probable and best established ; hence,
they were those that were taught and admitted in our colleges
and medical writings.
In a paper, on the Cause and Effects of an Obstruction of the
Blood in the Lungs, published in the 19th volume, 1823, of the
Edinburgh Medical and Surgical Journal, I have given an ac-
count of a series of experiments which I had performed. From
phenomena which were witnessed in these experiments, I de-
duce, “That the obstruction of the blood in the lungs, on
suspension of respiration, is not the effect of a mechanical cause,
that is of collapse or subsidence of the lungs; that the obstruc-
Dr. Williams’ Letter on Asphyxta. 381
tion of the blood in the lungs, on suspension of respiration,
arises from a deprivation of pure atmospherical air.” From
these deductions, and the facts, that an animal can survive only
a very limited time the suspension of the function of respira-
tion; and that the blood undergoes a wonderful change in con-
sequence of its being acted upon by the inspired air ;—I infer,
“That the blood cannot pass from the system of the pulmonary
artery into that of the pulmonary veins, without first undergoing
those unknown changes from the action of the inspired air.”
In my paper, I have noticed, that Harvey supposed the cir-
culation, in asphyxia, to be arrested in the lungs; Goodwyn
and Bichat in the heart. That Harvey attributed the vacuity
of the aortic system, after death, to an obstruction of the blood
in the lungs, in consequence of their collapse. That Goodwyn
and Bichat concurred in imagining asphyxia to be immediately
dependent upon the circulation of black blood, or blood of a
venous character; the left ventricle, according to Goodwyn,
ceasing to act “from a defect of a stimulating quality in the
bleod itself ;” the heart ceasing to act, according to Bichat,
from the circulation of black blood, (sang noir,) in the coronary
arteries, this fiuid stopping, (empéche,) the action of its fibres.
The error of these several views I have pointed out, and in con-
clusion, I have advanced the theory ; that the immediate cause
of the cessation of the action of the heart, on suspension of res-
piration, arises from the obstruction to the circulation in the
lungs, not from a state of collapse of these organs, as supposed
by Harvey, but from a deprivation of pure atmospherical_ air.
Further I have eursorily examined how far the obstacle to the
circulation of the blood, from a deficiency of pure atmospherical
air, 1s ‘adequate to explain the cause of some of the vital phe-
nomena observed in health and disease.
My paper, as I have above stated, appeared in the 19th
vol., 1823, of the Edinburgh Medical and Surgical Journal.
In the 29th vol. 1828, of the same Journal, Dr. Kay pub-
lished an essay, entitled, Physiological Experiments and Ob-
VoL..v. No. 15, 3D
382 Dr. Williams’ Letter on Asphywia.
servations on the Cessation of the Contractility of the Heart
and Muscles in the Asphyxia of Warm-blooded Animals, in
which he developes the same views, with respect to the im-
mediate cause of the cessation of the action of the heart, as I
had already done, by a similar or analogous series of experi-
ments. In this essay, no reference is made to my paper which
had appeared in the same journal, four years previously. ‘This
circumstance I mentioned to Dr. Kay. Dr. Kay, in 1831, pub-
lished further experiments on suspended animation, in the
North of England Medical and Surgical Journal. In this essay,
in a marginal note, Dr. Kay says, that I had called his attention
to my paper; and states my having anticipated him in one of
his conclusions, namely, “ That the obstruction of the blood in
the lungs, on. suspension of respiration, arises from a depriva-
tion of pure atmospherical air.” This marginal note is copied
into Dr. Kay’s recently published volume, on the Physiology,
&c. of Asphyxia. However, though Dr. Kay enters very elabo-
rately into the history of asphyxia, yet, no notice whatsoever is
taken of my having questioned the correctness of Bichat’s hypo-
thesis ; nor of my having advanced the theory, that the imme-
diate cause of the cessation of the action of the heart, or as-
phyxia, on suspension of respiration, is the effect of the circu-
lation being obstructed in the lungs.
T regret that any circumstances should arise to render it im-
perative on me to make this communication. But, in conse-
quence of the author of the article on asphyxia, in the Cyclo-
peedia of Medicine, and the reviewer of Dr. Kay’s recent work,
in.the Liverpool Medical Journal, having given Dr. Kay exclu-
sively the credit for being the first who pointed out the error of
Bichat’s hypothesis, and established, that the immediate cause
of asphyxia is the obstruction to the circulation in the lungs, I
deem it incumbent on me, in my own defence, to set the profes-
sion right on these points.
I am, Gentlemen, }
Your very obedient Servant,
Davip Wituiams, M, D.
Dr. Arrowsmith’s Letier to Dr. Graves. 383
P.S.—Should the subject of asphyxia be hereafter reviewed
in your Journal, I trust the reviewer will take the trouble of
examining the papers alluded to, and thereby satisfy himself of
the accuracy of this statement, and do justice accordingly.
Arr. XXTII.—Eztract of a Letter from Dr. Arrowsmith to
Dr. Graves.
Coventry, 19th April, 1834.
Sr,
In the 12th number you published a paper on some
forms of pneumatosis and in particular a case of emphysema fol-
lowing profuse hemorrhage, which at that time was quite a new
observation tome. Happening about the same period to consult
Portal’s Memoires sur la Nature et le Traitement de plusieurs
Maladies, I was agreeably surprised to find a long memoir on
pneumatosis, (or pneumatie, as he prefers to designate it,) in
which are contained many interesting observations on the mor-
bid development of air in different textures and under various
circumstances. Portal’s memoir contains references to nume-
rous writers, chiefly the older ones ; and professing as it does
to be a somewhat systematic treatise on the subject, I was sur-
prised that he did not notice the observations of J. P. Frank
which you have so much, and I doubt not, so justly commended.
{have not the work De Curandis Hominum Morbis at hand, but
since the publication of your paper I have looked into a few
works on this subject, without discovering in them any allusion
to the detailed memoir of Portal; under these circumstances I
have determined to take the liberty of directing your attention
to that work, confidently presuming that if it have already fallen
under your notice you will readily excuse me for troubling you
with this communication. Indeed I am the more’ induced to
384 Dr. Arrowsmith’s Letter to Dr. Graves.
address you from observing that so eminent and learned a pa-
thologist as M. Bouillaud, in the article Emphyséme, (Dict. de
Med. et Chir. Pratiq.) takes no notice of the writings of either
Frank or Portal, and appears to think that the secretion of air
can scarcely occur in the human body, at all events that, with
the exception of the instances adverted to by Morgagni, where
air was found in the cerebral vessels, it is when present due to
putrefaction, commencing even in the living body.
M. Rebolle de Gex, I observe, entitles his paper, on a New
Species of Emphysema, &c. ; but one of the first paragraphs in
Portal’s Essay appears to show that he was perfectly acquainted
with the: coincidence or dependence of emphysema in hemor-
rhage, “‘ La pneumatie,” he says, “ est encore plus fréquente
apres evacuations sanguines qu’aprés toute autre. Quon par-
coure les auteurs qui ont traité de cette maladie, et Yon y trou-
yera un grand nombre d’exemples. - Tout le monde connait d’-
ailleurs les pneumaties qui sont la suite de grandes hémorrha-
gies.” v. 107. :
~ Portal quotes cases of pneumatosis from suppressed ptyalism
and diabetes, from the retrocession of measles and suppressed
catamenia and diarrhoea, numerous examples in fevers, and se-
veral instances of the presence of air in the cavity of the pleura
combined with fluid effusion, almost always 1 think from pleuro-
pneumonia ;- indeed Portal insists much on the connexion of
inflammation with pneumatosis. There are cases also of gaseous
effusion into the pericardial cavity, and mixed cases of ascites
and tympanites. Emphysema of the cellular membrane as a re-
sult of inflammation, Portal thinks a not uncommon occurrence,
and he quotes Fontana for instances of the development of air
in that texture from the bites of venomous reptiles. It is evident
indeed that Portal thinks pneumatosis a morbid state which
might be frequently noticed, and on reading his essay one is
struck with the reflection that he must exaggerate its frequency,
otherwise practitioners would have been more familiar with it.
The elastic fluid formed in pneumothorax has been analysed
Dr. Arrowsmith’s Letter to Dr. Graves. 385
by the late Dr. A. Duncan and others, I think, and the obser-
vation of MM. Balley and de Gex on the inflammability of the
air, in the cases which they treated, are exceedingly interesting.
It is to be hoped, however, that further chemical experiments
will be made as opportunities present themselves, for no doubt
these gaseous secretions vary a good deal in composition. ‘Thus
Portal shews that they are sometimes not inflammable: “Tair,”
says he, “ en sortant se manifeste en faisant un certain bruit ; et
éteint méme une bougie allumée comme Morand et Senac Vont,
observé.” (p. 131.) On some occasions it is foetid, in more nu-
merous instances inodorous. Portal has quoted a case from
Daniel Hoffmann of emphysema from fractured rib, in which he
appears to imagine that air issued from a vein (with the blood)
when opened in the operation of venesection. He must, of
course, have been mistaken. His words are: “ La veine ayant
été ouverte par une saignée pratiquée a ce malade, l’air en sortit
en rendant un son comme celui dun sifflet.” (p. 186.) The
air must, I presume, have issued from the subcutaneous cellular
membrane at the same time with the blood, but not out of the
vein. Portal appears to have been aware of the fatal or injurious
effects of the experimental introduction of air into the veins,
and of the occurrence of sudden death from the opening of a
vein in the neck. Although I have said that Portal must have
been mistaken in his interpretation of the above case, he might
ask by what channels does the air effused in emphysema escape
if not by the usual course of absorption? I beg pardon for
occupying you so long, and am, Sir,
Your respectful and obedient Servant,
R. Arrowsmitu, M, D.
386 Mr. Nixon’s Case of Constriction of the Aorta.
Art. XXIV.—Case of Constriction of the Aorta with Disease
of its Valves, and an Anomalous Tumour in the Right
Hypochondrium. By Rozert Law Nixon, A. B., Licen-
tiate of the Royal College of Surgeons in Ireland, Surgeon
to Saint George’s Dispensary, &c. &c. &c.
La science posséde encore bien peu d’observations relatives au rétrécissement
et a Voblitération plus ou moins complete de l’aortas—R. J. Bertin des Mala-
dies du Coeur.
Tue truth of Bertin’s remark, as quoted above, is rendered
abundantly evident by the comparatively small number of well au-
thenticated cases of obliteration or constriction of the aorta with
which we are acquainted, the total silence observed on the subject
by some of our best writers on morbid anatomy, and the absence
in many of our most diversified and extensive pathological mu-
seums of any preparation to exhibit such lesions ;* it is therefore
hoped the accompanying case may not prove uninteresting, more
particularly as it was attended with some peculiar symptoms not
mentioned in those previously recorded, and as abundant op-
portunities were afforded of observing the progress of disease
from the moment it first became manifest.
Before entering upon its detail, it may not be unadvisable
to take a brief survey of a few of the most remarkable instances
with which we are acquainted of obliteration and constriction of
the aorta, as well for the purpose of contrasting them with the
present as with each other.
As might @ priori be concluded from the peculiarly impor-
tant part which the aorta bears in carrying on the circulation,
* In the museum at Guy’s Hospital, I find there are two preparations exhibit-
ing a more or less perfect obliteration of the aorta immediately above its bifurcation,
and ina third instance occurring to Dr. Bright, two points of obliteration were
found, one above, the other below the diaphragm, caused by cauliflower-shapec
masses of bony matter apparently of rapid developement.
Mr. Nixon's Case of Constriction of the Aorta. 387
an importance increased in proportion to ‘its proximity to the
heart, very few instances are afforded of obliteration of its arch
even after it has given off the great vessels to the head and su-
perior extremities, and ot one before it has accomplished that
purpose. Perhaps the most remarkable case on record is that
given by Mr. Graham of Glasgow, and inserted in the 5th
volume of the “‘ Medico-Chirurgical Transactions ;” it occurred
in the person of a lad named Henry Frere, aged fourteen, who
was admitted into the Glasgow Infirmary in August, 1813, la-
bouring, as was supposed from his symptoms, under pneumonia ;
he was treated accordingly, and left the hospital in the October
following “ cured ;” he returned again in November with all his
symptoms aggravated, and died the following month. Upon
examining the body, amongst other phenomena it was found,
that, after giving off the branches to the head and superior ex-
tremities, the diameter of the aorta was preternaturally contract-
ed, and continued so till its union with the ductus arteriosus,
when it became completely impervious ; its coats were not thick-
ened or diseased, the obstruction was about a line in breadth, the
ductus arteriosus was impervious. A case somewhat resembling
this, but differing essentially in the fact, that the ductus arte-
riosus was not only pervious, but of sufficient calibre to admit a
catheter, is given in the 33rd vol. (for the year 1815,) of the
“Journal de Medecine par Corvisart Leroux et Boyer ;” it
was here found that six or seven lines below the point where it
gives off the left subclavian, the aorta was obliterated for some
lines. In Dessault’s Journal de Chirurgerie, vol. 2nd, p. 108,
we find recorded the remarkable case given by M. Paris, de-
monstrator at the Hotel Dieu, it presented itself in a subject
brought in for dissection. After injecting the body the thoracic
and superficial abdominal vessels were observed to be tortuous
and remarkably enlarged, and upon further examination the
aorta was found to be contracted immediately beyond its arch
to the thickness of a writing quill ; its coats were natural, nor
could anything be found either in its own structure or the neigh-
388 Mr. Nixon’s Case of Constriction of the Aorta.
bouring parts to account for so singular a lesion. It is to be
reeretted that the state of the heart is not mentioned, nor could
any information be gained of the case previous to death. In
the first volume of Cooper and Travers’ Surgical Essays, a case
is inserted as having occurred to Mr. Winstone and Sir Astley _
Cooper. The constriction, as in Mr. Graham’s case and others,
took place at the point where the aorta is jomed by the ductus
arteriosus, (which was impervious,) and barely admitted the
passage of the little finger ; the heart was healthy, and the con-
striction appeared to depend upon a thickening of the circular
fibrous structure of the vessel accompanied with some ossifica-
tion of its coats. Cases somewhat similar to the above, but
occurring more frequently in the abdominal aorta, and in many
instances the result of various states of disease, are to be found
scattered through the works of different authors. It would be
needless here to detail the cases individually, but those who
are interested in the subject will find them in Stengel, in his
“ Dissertatio de Steatomatibus Aorta.” Meckel, (Memoires de
YAcadamie Royal de Berlin, 1756 ;) Stoerk, (Annals Med.
tom. ii. p. 262; Sandifort, (Observations Anatomie Patholog.
No. 10;) Morand, where the obliteration was the result of a
violent contusion, (Memoires de I’ Acadamie R. de Paris, 1736 5)
Brasdor, (Recueil Periodique de la Societe de Medecin a Paris,
No. 18;) Velpeau, (Revue Medical, tom. i. p. 326, ann.
1825 ; Beynard, (Journal Hebdominaire de Medicin, tom. 1.
p- 161; Dr. A. Monro, (on Aneurism of the Abdominal Aor-
ia ;) and also the very interesting case given by Dr. Goodison,
and which is published by Mr. Crampton in the second vol.
of the Dublin Hospital Reports, page 193, in the year 1813.
‘Dr. Goodison, in examining the dead body of a woman in the
Hospice de la Pitié at Paris, discovered a hard tumor placed
upon the aorta, and accompanied with an obliteration of that
vessel from the origin of the inferior mesenteric artery down-
wards the remainder of its length, At the obliterated part of
the abdominal aorta there was a firm bony sheath covering the
Mr. Nixon’s Case of Constriction of the Aorta. 389
vessel for about two inches, and filled with a hard fleshy sub-
stance, which extended further upward, and was firmly adherent
to the coat of the artery ; it was the inner coat itself which was
ossified ; the mitral and tricuspid valves were diseased, but
the general appearance of the body was not unhealthy, and the
lower extremities to all appearance had been sufficiently swp-
plied. This case, of which mention is made in Andral’s Pa-
thology, is essentially different from Graham, Paris, and others,
where no disease at the point of constriction could be detected.
In mentioning these cases I should not omit to add one pub-
lished in the first number of the North of England Medical
and Surgical Journal (August, 1830), by Mr. Joseph Jordan,
of Manchester. In this instance the constriction took place
about three lines below the union of the ductus arteriosus,
(which was impervious), and appears to have completely obli-
terated the vessel. As in the cases of Paris and Goodisson, a
subject brought in for dissection affords this example, and con-
sequently nothing of the previous history could be learned.
The pericardium was found distended with blood, which escap-
ed from a small fissure on the right and posterior side of the
heart. An abstract of this case is given in the 732nd page of
the second volume of the Lancet for the years 1829-—1830.
In the subjoined case the constriction resembled that de-
scribed by Paris and Graham, (no disease presenting at the
constricted part of the aorta,) and occurred in an individual af-
fording other and peculiar circumstances connected with ie
circulating system.
Doctor B., an English medical gentleman, aged 27, hid
himself under my care in July, 1833, labourmg under dyspep-
sia of rather an aggravated form, the result, as he supposed, of
some alteration which he had made during the preceding month
m his usually very temperate habits. He had a delicate, bilious
- appearance, but stated himself to be naturally of good constitu-
_ tion, but never very robust or strong, and mentioned that even
from his earliest days he was subject to occasional attacks of
YOu. y. No. Id. 3 E
390 Mr. Nixon’s Case of Constriction of the Aorta.
pain in the right side, accompanied by derangement of the
bowels, and other annoyances, which usually subsided in a few
days, without leaving any permanent inconvenience. The symp-
toms when he first sought my advice were, loss of appetite,
thirst, foul tongue, disinclination for exercise, slight pain in
the right hypochondrium, accompanied by tenderness and ful-
ness of the portion of the liver corresponding to this situation ;
his bowels were confined and his urine was high coloured. Un-
der the use of purgatives, antimonials, and a small quantity of
pil. submuriatis. hydr. comp., aided by strict attention to diet,
he rapidly improved; but in the course of a month returned to
me again, labouring, as he stated, under hepatitis. Upon ex-
amination, I found the liver much enlarged, painful to the
touch, and rather harder than natural ; he was put under such
treatment as his case appeared to demand, but improved slowly.
Early in September (about a fortnight after his second attack)
I perceived a small tumor situated below the margin of the
false ribs, and apparently placed upon the inferior portion of
the right lobe of the liver. In a few days after the tumor
was observed, I perceived it communicated to the finger a
slight pulsation, which increased daily, until at length it
became perfectly evident even to the eye; the tumor also con-
tinued to enlarge, and at the expiration of three weeks from
its first appearance it had attained the size of the half of a
small apple. It was accurately cireumscribed, and present-
‘ed both to the feel and by auscultation the peculiar pur-
ring thrill of aneurismal varix. ‘he action of the arterial sys-
tem, so far as it could be examined, was found to increase in
strength in proportion as the tumor and its pulsation became
more manifest ; this was peculiarly evident in the carotids and
‘right subclavian, whose throbbings became at length most un-
pleasant to my patient.* ‘Ihe aorta exhibited also a remarkably
loud bruit de soufflet through its whole course, and in addi-
* In Dr. Graham’s case, a precisely corresponding state of these vessels was
remarked,
Mr. Nixon’s Case of Constriction of the Aorta. 391
tion to his other somptoms, Dr. B. was troubled with consider-
able dysphagia, having had recourse, without advantage, to leech-
ing and blisters, with the internal exhibition of digitalis purga-
tives, and a strict attention to diet. I requested the advice of
my friend Dr. Wm. Stokes, who met me in consultation in the
last week of September (one month after I had first perceived
the tumor). Having given as much of the previous history of
the case as came within my knowledge, and the detail of the
treatment, a most careful and minute examination was made
both by the stethoscope and otherwise, and having been fre-
quently repeated during the succeeding days, we came to the
opinion,—that inflammation of the ining membrane of the aorta
existed, that the liver was enlarged, the enlargement being pos-
sibly congenital, at least to a certain degree, and that the pul-
sating tumour in the hypochondrium was in all probability
aneurismal, but from its position, and the peculiar circumstances
attending it, we felt great difficulty in determining its seat or
actual nature.
In addition to the previous treatment, in which it was agreed
our patient should persevere, he was directed a Belladonna
plaister to the side, to be worn constantly, and renewed from
time to time; and he was also advised to remove from town.
He accordingly left Dublin for the country, where I had the
opportunity of seeing him as often as he might require. Through
the months of October and November, he persevered in the
treatment laid down for him by Dr. Stokes, who occasionally
saw him, and agreed with me in thinking that matters grew
progresssively worse, and that a sudden death at no very distant
period was the only result to be anticipated,—the action of the
heart and arterial system becoming daily more violent, and
the pulsation in the tumor increasing both in strength and in
its progress towards the surface. In the latter part of Novem-
ber he incautiously exposed himself to cold,* and the result
———
* In Mr. Graham’s case a similar cause appeared to produce the fatal symp-
£OMS.
392 ‘Mr. Nixon’s Case of Constriction of the Aorta.
was an attack of Bronchitis, attended by considerable dyspneed.
His extreme weakness, the result in a great measure of the ne-
cessary medical treatment, combined with the very low diet un-
der which he had been placed for some months, forbade the ab-
‘straction of blood; but other means failing: to afford relief,
and the symptoms becoming more and more urgent, particu-
larly the cough, which, under existing circumstances, was much
to be dreaded, I directed three leeches to be applied over the
trachea in the supra-sternal depression, and their bleeding to be
carefully watched. Owing, however, to carelessness or want of
skill on the part of the nurse-tender, or perhaps in consequence
of the uncoagulable condition of the blood, dependent on his
strict abstinence, the oozing from the leech-bites was permitted
io continue for forty hours before I was again summoned. On
my arrival I found my patient perfectly blanched, his pulse
scarcely perceptible, his voice feeble, and his strength at its
‘jminimum ; in fact, he appeared almost moribund ; the bleed-
ing from the three orifices was still continuing freely, and from
what L saw and could learn, the quantity of blood lost was much
more than I conceived my patient possessed ; of course my first
object was to prevent further hemorrhage, which I readily ac-
complished by making compression with a graduated com-
press on the bites, having previously inserted into their orifices,
by means of a small blunt probe, a minute portion of the beaver
from a black hat, a material I have always found to be of pecu-
liar utility on such occasions.* Placing my hand casually on
the situation of the tumor, I perceived it was diminished in
size, that its pulsation was much weakened, and it was also
observed, as well by my patient as myself, that the distressing
throbbing of the vessels in the neck had nearly ceased. ‘These
circumstances, however, I attributed to the great loss of blood,
%* The black beaver seems to act not only mechanically by its pressure, and
also by its filaments delaying the blood as it passes, and thus favouring coagula-
tion, but also somewhat chemically, probably owing to the styptic nature of the
different substances used in dying it.
Mr. Nixon’s Case of Constriction of the Aorta. 393
by which the power of the circulation generally was so re-
markably weakened. Fearing the result of such a sudden
and extensive drain upon the diminished strength of my patient,
I was induced not only to allow him animal food, in properly
reculated quantities, but also to add half a glass of wine two or
three times each day. His medical treatment was also mate-
rially. altered. Quinine, to the extent of two grains, three
times in the day, and quarter of a grain of acetate of morphia,
being substituted for his digitalis and purgatives.
At one of my visits a few days after, I was agreeably sur-
prised to find that, although the pulsation at the wrist was much
stronger, that in the tumor was not proportionably so; and
from this period (24th November) daily decreased, until at
length it altogether ceased. About ten days after the applica-
tion of the leeches, its declension was accompanied by a. cor-
responding diminution in the size of the tumor, which continued
from day to day to get smaller and harder, until it had assumed
somewhat the feel and size of half a marble. Tven here it did
not rest, but before Christmas had so totally disappeared as to
leave no trace whatever of its previous existence, even on the
most accurate examination, nor could it ever be detected after
this period.
On the Ist of January I was hastily summoned to see my pa-
tient, who, I was informed, was dying. On my arrival I found
him labouring under spasmodic dyspnoea, accompanied by vio-
lent pain under the right scapula and down the side. This ap-
peared to depend upon rheumatism of the intercostals, as it was
increased during their action, and pressure on them caused con-
siderable distress; in fact, he had never completely thrown off
the attack of bronchitis which he contracted in November, and
the present annoyance I was induced to refer partly to this
cause and aided by some additional cold. His Quinine was ne-
cessarily suspended, his diet reduced, and ether and Morphia
given freely ; warm turpentine frictions were applied to the side
and shoulder, and under this treatment the recent attack was
394 Mr. Nixon’s Case of Constriction of the Aorta.
subdued, and in a few days the lost ground was regained. He
was now removed to town, his Quinine, animal food, and wine
were restored to him, and their quantity gradually increased.
His strength returned, his appetite improved, and he even be-
gan to put up flesh, and ceased to be the perfect anatomieé vivant
he was. [Exercise in a carriage was now recommended, and
used, and at the beginning of February he was able to walk a
mile with great comfort, and very imconsiderable fatigue. He,
however, felt himself so well, as to make him careless of using
the precaution to which he had been so long accustomed ; he
even went out sometimes in the evening, and on one occasion did
so when the weather was very severe; the result was another
attack of bronchitis, attended by dry harassing cough, dyspnoea,
loss of appetite, superficial excoriation of the fauces, and hoarse-
ness. The plan of treatment found so serviceable in the former
nearly similar attack was again put in practice, and with suc-
cess, though not so rapidly as before. Matters continued sta-
tionary for a few days and then began to amend; but a new and
most unfavourable symptom now presented itself, namely, ana-
sarca of the lower limbs; for its relief, diuretics, stimulating
liniments, warm pediluvia, bandages, horizontal position, &c.
&c. were resorted to, and with temporary advantage. The im-
provement was, however, only of short duration, the anasarcous
effusion gradually progressed towards the trunk, and advanced
until it pervaded in a greater or less degree the cellular system
of the entire body. The difficulty of breathing was increased
_ most alarmingly, accompanied by ascites and tympanitis; for
the relief of the former, diuretics and purgatives of various
kinds, and in different combinations, were ineffectually exhib-
ited ; the latter was much relieved by the administration
through a long tube of a large foetid enema with turpentine.
I{ffusion now took place into the cavity of the chest. ‘The following
day a blister was applied with some advantage ;. the sputa be-
came tinged with blood, and great difficulty was found in their
discharge. Matters got worse ; he was directed camphor mix-
Mr. Nixon’s Case of Constriction of the Aorta. 395
ture, with Hoffman’s anodyne and expectorants ; another blis-
ter was applied to the chest, and, as in the former instance,
with improvement, but for a very short time. At this period
an emetic was recommended in consultation, in order to endea-
vour to act on the overloaded air cells, and improve his powers
of respiration by assisting a more free discharge of the mucus
which they contained. Accordingly, an ounce of hippo wine
was taken with a few hours advantage; the symptoms, how-
ever, returned on the succeeding day with increased violence ;
every attempt even to relieve his distress proved ineffectual,
and my patient expired on the morning of the 12th April, re-
taining his mental faculties in perfection to the last moment ;
his death, though slow, was still in one sense of the word sud-
den, as he expired a few seconds after he had spoken to me re-
lative to some pain he felt in the posterior part of the neck.
Post mortem.—Having expressed a great desire to examine
the body, with a view to ascertain the nature of the tumor,
whose appearance and subsidence | had so anxiously watched,
a post mortem examination was kindly permitted, which I made
the morning alter his decease, assisted by my friends, Drs.
Cuthbert and M‘Dowell, physician and consulting surgeon to
Saint George’s Dispensary, and Mr. Charles Holmes, apothe-
cary to the institution. I had hoped for the advantage of Dr.
Stokes’s presence, to whose valuable assistance I was so much
indebted during the treatment of this interesting case, but his
professional duties prevented him attending at the hour named,
and particular circumstances did not permit of delay.
The general appearance of the body was, as might be sup-
posed, indicative of the anasarcous effusion, which, as I have
mentioned, pervaded every portion of the cellular tissue, even
that of the forehead and face. ‘The skin was tense, shining,
of very peculiar whiteness, and pitting upon pressure. ‘There
was a remarkable wasting of the muscular system, and an al-
most total absence of adipose structure. Upon examining the
right hypogastrium, there did not appear any trace of the tumor
396 Mr. Nixon’s Case of Constriction of the Aorta.
through the muscular parietes, but from frequent examination
during life I could point out accurately the precise situation
where it had presented itself for a period of nearly four months.
Having laid open the abdomen by a crucial incision, a quantity
of fluid was found in the cavity. The liver immediately pre-
sented itself to our notice considerably enlarged, and pressing
down between the margins of the ribs and sternum ; it was pe-
culiarly hard, and exhibited over its outer surface several large
yellow tubercles. On examining that portion which correspond-
ed to the point at which the tumour had presented itself, I was
surprized to find no appearance whatever of swelling, enlarge-
ment, or even irregularity of surface, connected either with the
viscus, or in the abdominal muscles, nor did any adhesion ex-
ist between these parts. The liver being cautiously removed
and submitted to careful examination, we were not able to dis-
cover the slightest trace of tumor in or about it; when handled,
the part where the tumor had been supposed to have its place
felt rather harder than the other portions, but upon carefully
cutting into it, no cause for such hardness could be found, nor
did any trace appear of the remains of an abscess, or of any de-
position of lymph-fibrine, or coagulated blood ; the tubercles,
some of which were evident on the external surface, were so
very abundant in the internal as to give to the whole organ a
yellowish tinge; the enlargement and hardness extended to
every part of the viscus ; the gall-bladder contained about two
ounces of healthy looking bile. |
The stomach and intestines were perfectly healthy, the lat-
ter particularly diminished in calibre, owing of course to his
nearly perfect abstinence for some weeks before his death. The
colon, however, is to be excepted, as it contained a great quan-
tity of flatus, and thus accounted for the tympanitic symptoms.
the omentum presented scarcely a trace of adipose structure ;
the kidneys were larger and paler than usual, and the ureters
appeared to be increased in size and strength. The spleen was
large, soft, and distended with peculiarly dark coloured blood ;
Mr. Nixon’s Case of Constriction of the Aorta. 397
the pancreas was normal, nor could any alteration be detected
in any branch of the cceliac axis; so far then as the abdomen
and its contents were concerned, we found nothing to account
for the tumor or its pulsation. We next proceeded to examine
the thorax, in the cavity of which we found a considerable
quantity of water of the usual character. The lungs appeared
emphysematous on their surface, and gorged with blood, espe-
cially their posterior region. The superior lobe of the left lung
was so completely hepatized as to sink when placed in water,
and in truth looked more like the structure of a (healthy) liver
than the one before us did. Upon cutting into them, their in-
ternal structure exhibited, as their external did, an emphysema-
tous appearance ; the small air-cells were rendered impervious
to air by the effusion of a frothy sanguineous fluid, which the
larger contained in great quantities. The trachea also, and its
various ramifications, were coated by it, and bore evident marks
of inflammation of their lining membrane. The larynx was not
examined, but would doubtless have presented similar. appear-
ances. ‘The pericardium, when cut into, appeared healthy in
structure, but contained a few spoonsful of straw-coloured fluid ;
the heart was larger than natural, the increase depending, as
was afterwards proved, upon excentric hypertrophy of the left
ventricle. The coronary vessels were dilated and filled with
dark coloured blood. The dissection of the heart, which was
most carefully made, exhibited the following particulars, of
which notes were taken at the moment: ‘The organ (as has
been stated) was large and fleshy, exhibiting hypertrophy of
the left ventricle with dilatation ; the interventricular septum
thick and fleshy; the right ventricle smaller than natural,
caused apparently by the projection into it of the thickened
septum ; the right auricle large, the left normal; the auriculo-
ventricular openings, on both sides, enlarged ; the aorta at its
origin was healthy in structure and natural in size. A small
abscess, about the size of a pea, was found in the muscular
structure of the heart, near the point where it is joined by the
VOL. Vv. No. ‘TS. . ? 3F .
398 Mr. Nixon’s. Case of Constriction of the Aorta.
aorta; the art. innominata considerably and the left subclavian
slightly increased in calibre ; the left carotid normal ;* all the
blood extremely dark in colour, owing to the imperfect oxy-
dation it obtained in consequence of the diseased: state of the
lungs. The aorta, in its transverse portion, just at the point
where it is joined by the ductus arteriosus,t exhibited a very
singular constriction, similar to what would occur if a sharp in-
strument had been pressed upon its upper surface until it had di-
minished the calibre by about one-half. This will be better under-
stood by reference to the accompanying plate, and the prepara-
tion from which it was taken, which is preserved in the museum
attached to the Richmond School of Surgery. ‘There was not,
however, any deposition in its coats of osseous or calcareous
matter at this point, and the ductus arteriosus was ‘pervious.£
The aorta, in the remainder of its course, appeared perhaps a
little narrowed in its calibre, but normal in structure, if we ex-
cept a few atheromatous spots on its lining membrane ; the pul-
monary artery, natural. Upon passing in the finger for the pur-
pose of examining the state of the aortic valves, we were sur-
prized to observe that it could not find a passage either from
the heart to the aorta, or vice versd ; but upon laying open the
vessel, the difficulty was very easily explained, the valves being,
if not removed, at least completely obliterated by an irregular
fleshy mass, which grew from the line of junction of the vessel
with the heart, and almost totally filled the canal.§ Several par-
_ * This exactly corresponds with the state of the vessels in the cases detailed by
Mr. Graham and M. Paris.
+ Itis a remarkable fact, that in the cases given by Mr.Graham, M. Paris,
Corvisart, Sir A. Cooper, and Mr. Johnston, the point of constriction correspond-
ed almost accurately with that in the present instance.
-*+ Except in Corvisart’s case, the duct was always found in this state.
§ This ‘growth is described by Corvisart and other French writers under the
term ‘‘vegetations.” Several specimens are now preserved in the different museums,
and notice is taken of them by Mr. Wardrop, the editor of Dr. Baillie’s works, as
the Doctor does not himself allude to them.
Mr. Nixon’s Case of Constriction of the Aorta. 399
ticles of phosphate of lime were deposited in the mass, in par-
ticular, one very hard and white portion presented itself, about
the size of a small bean. The communication between the heart
and aorta was reduced to an irregular slit-like opening, through
which a common probe could not pass without some difficulty ;
and yet, through it all the blood of the system found its way.
Here, then, was the seat of disease, for if we except the dropsical
symptoms and the diseased state of the lungs, which are to be
considered more as effects than causes, and were only of late
occurrence, it was, with the morbid state of the aorta, the sole
clue which dissection afforded to assist in unravelling the diffi-
culties of this very curious case; and with all the evidence be-
fore us, it becomes an inquiry not devoid of interest to con-
sider what share had this morbid growth, and the diseased ac-
tion of the heart and aorta consequent upon it, in the production
of the tumor, whose existence for nearly four months has been
already detailed? What was the nature of the tumour, and
where situated ? to what did it owe its pulsation? If to the ac-
tion of the enlarged and diseased heart, why should it decline
and ultimately disappear, when that organ must have been daily
becoming more and more anormal ? If to the aorta, or one of the
branches of the coeliac axis, or any enlarged branch of the hepa-
tic artery, why could not the post mortem exhibit it? Was it
a simple abscess of the liver obtaming pulsation from some
neighbouring part ? No trace of such a lesion could be detect-
ed. Was it the liver pushed out of its natural situation by the
enlarged heart, whose impulses it received? This might ac-
count for an extensive projection in the right hypochondrium,
and a corresponding extent of pulsation, but could scarcely ex-
plain a defined tumor, and a pulsation confined merely to its
summit, accompanied by the purring thrill already noticed.
But even if we receive it as the cause, we would still have to
account for this circumstance, why did the tumor and its throb-
bing gradually decline and ultimately disappear, when it must be
manifest the causes of their origin, (if we grant the morbid state
400. Dr. Stokes’ Researches on the
of the heart and aorta were so), from the progress of the dis-
éase, were becoming daily more and more likely, at least to
continue, if not to increase them. The same difficulty, or per-
haps a greater, would be found in endeavouring to explain the
cessation of the throbbings in the different great vessels, if we
did not conclude that it depended upon the increase of the dis-
ease at the mouth of the aorta, and the consequent diminished
stream of blood circulating in the vessels.
EXPLANATION OF PLATE.
a The Aorta.
b The Pulmonary Artery.
e The Arteria Innominata.
d The Left Carotid. —
e The Left Subclavian. |
-f The Ductus Arteriosus.
~g The Constriction.
Arr. XXV.—Researches on the Diagnosis and Pathology
of Aneurism. By Wiiiiam Stoxrs, M. D., Member of
the Association of the Fellows and Licentiates of the King
and Queen’s College of Physicians in Ireland, Correspond-.
ing Member of the Medico-Chirurgical Society of Berlin,
Honorary Member of the Hunterian Society, one of the
Physicians to the Meath Hospital and County of Dublin.
Infirmary, and Lecturer on the Practice of Medicine in the
School of Anatomy, Medicine, and Surgery, Park-street,
Dublin.
Tw the following communication I shall lay before the reader
the particulars of several cases of Aneurism, which illus-
trate some interesting points in the history of the diseases of
the great vessels. I shall then make some general observa-
tions on Arterial Pathology, and shall have the pleasure of
inserting an important communication from Professor Harrison
on this subject.
gay
Prom Medure K on Stone by W Uden |, over,
¢Y
MP NIXONS. CASE OPSOCONSTRIC TION Vefihes: AORTA.
Diagnosis and Pathology of Aneurism. 401
‘Case I.—Aneurism of the Hepatic Artery with consequent
Obstruction and Distention of the Biliary Ducts.—Jaun-
dice.—Death by Rupture into the Peritoneal Cavity.
Samuel Meares, xtat. 35, a man of regular habits, but who
had formerly suffered from apoplexy, was admitted into my
wards on the 7th of August, 1832, in a state of complete jaun:
dice. ‘Nine weeks ago, while in the enjoyment of good health,
he was attacked with copious heematemesis, which subsided un
der treatment in about five days, leaving him, however, with
impaired appetite and constipated bowels. For these com-
plaints he attended at a dispensary. On the 29th of July, ‘he
first observed the legs and arms slightly yellow.. The only
other remarkable symptom was drowsiness. Next day the
nausea increased, he had some pain in the epigastrium, the
jaundice was universal, and he had yellow vision. _ |
On admission he had thirst, nausea, and some epigastric
pain, increased by pressure; but of this he did not complain
much. Feces and urine affected as in jaundice. Pulse 112,
tremulous. | |
The abdomen appeared generally tumid, but particularly
so in the epigastric region, where the left lobe of the liver could
be felt as if much enlarged, and stretching towards the left
hopochondrium. ‘The right lobe seemed also enlarged, its
lower margin extending to the umbilicus. About two inches
to the right of this situation I detected a soft pyriform and
fluctuating tumour, which I concluded was the gall bladder in
a state of distention. The liver felt unequal and was tender to
pressure.
In this state he continued for nine days, without any change
of importance in the local signs or symptoms. He became
covered by a miliary and afterwards a petechial eruption. The
pain and tenderness in the tumour were variable, the jaundice
persistent. In none of our examinations did we detect any re-
markable pulsation of the tumour, nor did the patient complain
of pain until he was questioned, or a manual examination made.
On the seventh day, though if possible more deeply jaundiced,
402 Dr. Stokes’ Researches on the
he declared that he saw all objects of their proper hue. He
had thirst; anorexia, and for some time a morbidly clean and
livid tongue.
On the morning of the 17th of August, he sat up in bed for
‘some purpose, grew faintish, leant back, and speedily expired
without a struggle, and seemingly without pain.
Dissection.—The body presented the usual appearances of
jaundice. On opening the abdomen, the whole of the intestinal
convolutions were concealed. from view by a layer of soft and
recently coagulated. blood, which was moulded into the diffe-
rent folds. This wasremoved and found to fill a quart vessel.
The liver, contrary to expectation, was found rather small,
but very prominent, and beneath its thin edge were seen two
projecting tumours; one, the gall bladder, enormously dis-
tended with bile, and remarkably stretched ; the other occurre
to the right of the former, and occupied the notch in the ante-
rior edge of the liver. It was of the size of a large orange,
roughly coated with cellular membrane ; generally adherent, and
without fluctuation. It now appeared that the apparent enlarge-
ment of the liver was caused by its displacement, its being
pushed from behind forwards by these tumours. The second
tumour was strongly bound down to the spine, with the pan-
creas encircling its lower half, I now made a careful examina-
tion of the aorta, which was every where healthy, and had no
communication with the tumour. Under these circumstances
I proceeded to a careful examination of the tumour and liver,
in which I was assisted by my colleagues, Messrs. Porter and
Collis, and also by Dr. Houston, curator of the Museum of
the Royal College of Surgeons. The tumour proved to be
an aneurism of the hepatic artery, covered by the capsule of
Glisson, and some cellular membrane, and so situated as to
press directly on the bile duct. Its interior was fiocculent and
contained some coagula. ‘The opening in the vessel was well
defined, forming an oval slit, and seemed the result of perlect-
ly circumscribed disease.
Diagnosis and Pathology of Aneurism. 403,
~The portal veins were seen ramifying and dilated on the
inner and inferior face of the tumour, which had ruptured by.
a rent on its antero-inferior surface.
The state of the biliary ducts throughout the liver was most
singular. They were enormously dilated up to their termina-
tion. The larger ducts could admit a man’s thumb ; the dila-
tation continued to the peritoneal surface of the liver, where
numerous projections, varying from the size of a walnut to that
of a pin’s head, were formed apparently by the distention of
their ultimate ramifications; these contained bile, and when
opened, that fluid was ejected with considerable force; their
colour was of a dark green. The substance of the liver was fri-
able and soft, and seemed engorged with bile;* no disease
could be detected in any part of the gastro-intestinal sur-
face.
[ have placed this case the first in the present selection, as
our knowledge of aneurisms of the hepatic artery is as yet ex-
tremely limited. I have not been able to find any instance
where the symptoms of this affection were observed during life ;
and, though I confess, that in this case I had no suspicion of
the nature of the disease, and consequently that the observa-
tion is imperfect, yet the case presents some important points
which may hereafter assist us in the diagnosis of the dis-
ease.
The patient had enjoyed good health up to the period of
the attack of heematemesis; he then continued: ailing until the
supervention of the jaundice, at which time the first decided
* A somewhat similar. state of the liver is described by Mr. Lloyd, in the last
number of the Medico-Chirurgical Transactions of London. In his case the ob-
struction to the biliary ducts was caused by disease of the pancreas and duodenum.
The hepatic and cystic ducts were so enlarged as to resemble a portion of small
intestine, and the liver was full of bile. It is remarkable that the hepatic tumour
presented the sign of fluctuation during life, which is attributed by Mr. Lloyd, in
part at least, to the distended state of the biliary ducts.
404 Dr. Stokes’ Researches on the
symptoms, namely, pain in the epigastric region, with nausea,
made their appearance ; this was about ten days previous to his
admission, and as far as we could collect, this was also the
period when the tumefaction was first observed.
L observed to the class that there was something exceeding-
ly obscure in the nature of the case, for the apparent tumefac-
tion of the liver, considering it to be the result of chronic hepa-
titis, was much greater than could be expected to have occurred
sn the course of so short a time; I may add that I formed no
conjecture as to the cause of the distention of the gall bladder,
nor was any stethoscopic examination performed, a circumstance
which I now deeply regret. But that there was no manifest
pulsation I feel confident, as such could scarcely have escaped
us, in our repeated “examinations of the tumour; nor, as far as
I know, did the patient ever complain of any feeling of pulsa-
tion in the part.
It will be seen how completely the dissection accounted for
the anomaly as connected with the rapid tumefaction of the li-
yer, which organ was not enlarged as we expected, but dis-
placed by the pressure of the aneurismal tumour. A similar cir-
cumstance is recorded by Dr. Beatty, in his account of the re-
markable case of aneurism of the abdominal aorta, which he
has inserted in the Sth vol. of the Dublin Hospital Reports.
In this case, sometime before death, the liver appeared dis-
tinctly enlarged, the tumefaction increasing daily in size; the
patient died by rupture of the sac into the right pleura. I shall
quote the following from Dr. Beatty’s account of the dissection:
« Before proceeding to the dissection,” says Dr. Beatty, “‘ we
wished to let some of the gentlemen present, who had not at-
tended him, feel the enlarged liver, but we were much surprised
to find that no tumour could be perceived; this, though at
the time inexplicable, was afterwards satisfactorily accounted
for.” |
Dr. Beatty having described the healthy state of the liver,
with the exception of some indentations corresponding to the
Diagnosis and Pathology of Aneurism. 405
ribs on its convex surface, concludes by the following remark :
“‘ The apparent increase of size in the liver, in the case of Mr.
M. was evidently caused by the great bulk of the aneuris-
mal tumour pressing it downwards, and forcing its inferior mar-
gin below the ribs, and the difficulty in discerning it after death
before the body was opened, was the result of the bursting of
the sac, by which its size was diminished, and the liver was suf-
fered to resume its original position. The deep indentations
with which the liver was marked, gave evidence of the pressure
to which it had been subjected, and may account for the attack
of pain in the right side, which so much resembled hepatitis.”
One of the most remarkable circumstances in our case was
the slight degree of pain complained of ; in this respect it differs
much from many cases of aneurism of the abdominal aorta, in
which, as in Dr. Beatty’s case, dreadful colics form the promi-
nent symptom. Should future observations establish the com-
paratively painless character of aneurisms of the hepatic artery ;
we may thus arrive at an additional diagnostic. Indeed, when
we consider that the hepatic artery, (unlike the abdominal aorta,
particularily at its upper portions,) is not bound down by any
strong or unyielding tissues, but les in a capsule of extensible
serous membrane, we can understand that its aneurismal en-
largement may occur with little or no pain.
The same circumstance too may probably be found to ac-
count for the absence of the usual violent pulsations of an aneu-
rismal tumour, at least during the early periods of the case.
The violence of impulse, both of the heart and arteries, im
health or disease, seems ceteris partbus to increase in propor-
tion to the resisting nature of the surrounding parts. I feel
little doubt that the violent impulse of the heart in phthisis is,
to acertain degree at least, produced by the circumstance, that
the lung has lost much of its elasticity, and thus offers greater
resistance to the motions of the heart.
In conclusion it is to be observed, that in aneurism of the
hepatic artery, as in this case, and in that of the abdominal
VOL. v. NO. 15. 3G
406 - Dr. Stokes’ Researches on the
aorta, as in Dr. Beatty’s case, we have causes, before unobserv-
ed, for apparent enlargement and other diseases of the liver.
These facts then must be kept in view in the diagnosis of ob-
scure affections of the liver or gall bladder.
Case I.—Aneurism of the Arteria Innominata, with Hemi-
plegia.—Dysphagia and Stridulous Breathing.— Oblite-
ration of the Right Carotid and Subclavian Arteries,—
the Jugular Veins, and Vene Innominate.
Michael Mears, a shoe-maker, et. 34, square built and
muscular, was admitted into the Meath Hospital, December
20th. The leading symptoms at the time of admission were,
cough, difficulty of breathing, and pain in the chest, head, and
neck. The night after admission, however, he was attacked
with hemiplegia of the left side. He states that some years ago
he had syphilis, and has several times since then been mercu-
rialized for what he calls rheumatic pains. Twelve months ago
was in Steven’s Hospital for one of these attacks, the pain at
that time chiefly affecting his shoulders, head, and back. Was
cured in about a month by blisters, warm bathing, and purga-
tive medicines. From that time till the present attack had en-
joyed what he believed to be good health, although subject to
attacks of shortness of breath, particularly after any considerable
effort, also to numbness of the right arm.
The present symptoms came on about five weeks ago, after
exposure to a strong current of cold air, having sat for several
hours at work near to an open window. Before leaving his
work he was attacked with pain in the chest, neck, and head, and
on the following day these symptoms were followed by a short
dry cough, stiffness of neck, sore throat, and some difficulty in
swallowing. The pain in the chest, however, was chiefly con-
fined to the upper part of the right side, and was much aggra-
vated on making a deep inspiration. He attended for advice at
the dispensary, and was bled, blistered, &c., but finding his dis-
ease getting worse, he applied for admission into hospital. Had
continued his employment until four days ago. Mr. Power,
Diagnosis and Pathology of Aneurism. 407
the resident pupil, made a hurried examination of the chest
with the stethoscope, detected the signs of dry pleuritis under
‘the right’ clavicle, and had him admitted. The next morning
was found in a state of somnolence, and when roused answered
the questions put to him sluggishly and in a thick and indistinct
voice. The left side was almost wholly deprived of sensation and
motion ; while the mouth was drawn to the right; and the tongue
protruded to the opposite side, the patient not having the power
of directing it to the right. Pupil of the affected side (the
left) slightly dilated; sensible to the stimulus of light, but less
perfectly so than the other. Hearing somewhat impaired. He
states that he got out of bed during the night to go to the night
chair ; on attempting to return felt giddy and unable to support
himself, and was obliged to seize hold of the side of the bed
for support ; his hands, however, gave way and he fell on the
floor. Says he never had an attack of the kind before, but
since he was first attacked, (five weeks ago,) has had pain and
noise in the head,.ringing in the ears, giddiness on stooping,
and occasionally flashes of light passing before the eyes ; just
before he got out of bed he was attacked with slight numbness
in the left arm, which gradually increased, and extended to the
left leg. Complains of violent pain in the right side and back
part of the head and neck, difficulty of swallowing, cough,
dyspnoea, and pain in the chest. Cough of a laryngeal cha-
racter, with scanty, frothy, mucous expectoration; respiration
18; pulse 84, and full in the left wrist, but exceedingly indis-
tinct in the right, nor on a careful examination could any pul-
sation be detected in the brachial or axillary artery on this
side ; tongue loaded, with a streak of dark brown fur down
the centre ; great thirst ; costive bowels, and involuntary mictu_
rition ; temperature of the two sides nearly equal.
The chest sounds well over its whole extent, excepting the
sternal extremity of the right clavicle, which sounds decidedly
dull. Respiration in the left lung intensely puerile, but exceed-
ingly feeble in the right, both anteriorly and. posteriorly, and
408 Dr. Stokes’ Researches on the
without rale. On applying the stethoscope to the sternal ex-
tremity of the right clavicle a very loud double pulsation was
discovered with a strong impulse, but diminishing in intensity
as the heart was approached ; the sounds and impulse of which
were natural. On pressing the fingers behind the clavicle a
small pulsating tumour could be felt in the direction of the
arteria imominata. No bruit de soufflet could be detected in
any part of the chest.
These symptoms were materially relieved by local bleed-
ings, cold applications to the head and neck, and purgative
medicine; but on the 5th of January, all his former symptoms
were much aggravated ; and he was attacked with diffuse cellular
inflammation of the integuments of the neck, extending from the
clavicle to the inferior maxilla; the swelling was soft and elastic,
with little discoloration of its surface ; but extremely tender to
the touch, and with distinct crepitation on pressure. The face
was livid and swollen, and the superficial veins of the head and
neck much engorged, but particularly on the right side; breath-
ing laborious, hurried, and accompanied with a loud tracheal
rattle ; deglutition difficult and attended with ‘considerable
pain; pulse 96; bowels free, but the urine again passed
involuntarily. Jor the relief of these symptoms leeches were
applied, followed by spirituous applications to the neck, and
the bowels were kept regular with the purgative pills of the
house, and enemata, Under this treatment he again obtained
temporary relief, for on the 16th J anuary we have the following
report :—Rests well, but complains of being very weak. . The
diffused swelling of the neck and face has disappeared, and the
superficial veins of the head and neck are less distended ; ‘head-
‘ach less intense, although still violent, (a very prominent symp-
tom since he entered hospital,) pupils of equal size and equally
sensible to the stimulus of light. Has a perfect command over
the sphincter and bladder. The pain in the right side of the
neck continues, and he usually lies with his head bent towards
the right shoulder, feeling most ease in that position. No re-
Diagnosis and Pathology of Aneurism. 409
turn of power in the hemiplegic side. The dulness was found
to extend over the two internal thirds of the right clavicle, and
a finger’s. breadth below that bone. A distinct but nota defined
tumor can now be felt pulsating behind the sternum and sternal
extremity of the clavicle, with a stronger impulse than on ad- —
mission; and the double sound more distinct. than over the
region of the heart ; appetite good, but aircon of some dif-
ney of calla wii: Lpeaectns?
On the 25th of January he aoolatga of acute pain be-
tween the shoulders, shooting up the back of the neck to the
head ; pain in the head much worse. The tumor has greatly
increased in size, (its pulsations may now be seen at some dis-
tance from the patient,) it extends about an inch above the cla-
vicle, and is bounded internally by the mesial line, and exter-
nally by the posterior border of the sterno-mastoid muscle.
My period of attendance on the hospital having arrived, I
received this patient with the foregoing observations from my
colleague, Dr. Graves. I found him complaining of severe pain
in the head and neck, which he compared to the sensation of
boiling water passing down his neck. ‘The tumor was increased
in size, but from a pulpy state of the integuments appeared
larger than it perhaps was. The superficial veins of the head
and neck, particularly on the right side, were greatly engorged.
' Respirations 24; pulse 86, soft and regular, but nearly absent
in the right arm. Notwithstanding the increase of the tumor
- there was less dysphagia. Nearly the whole of the right cla-
vicle‘and two fingers’ breadth of the right sub-clavicular region,
with the superior third of the sternum sounded completely dull.
The impulse and sounds of the tumor as before, and still with-
out bruit de soufflet. The remainder of the right side sound-
ed clear, but the respiratory murmur was werk ee gly feeble,
while in the whole of the left lung it was intensely puerile.
I determined to try the effect of small repeated bleedings ; at
the same time supporting the patient's strength by a little solid
animal food; I also directed that he should use as little fluids
as possible.
410 Dr. Stokes’ Researches on the
The first bleeding was performed on the 28th; six ounces
of blood were drawn ; he bore the operation well. The head
was much relieved. On the next day the expression of counte-
nance was improved, and the turgescence of the veins diminish-
ed. This improvement was but temporary. In two days his bad
symptoms returned, and the turgescence of the superficial veins
became as great as before. The bleeding was repeated, and
the use of digitalis, squill, and calomel, which had been order-
ed on the 28th of January, was continued. Slight relief fol-
lowed ; but the aneurismal tumor continued to increase. He
had stridulous breathing, laryngeal cough, and dysphagia ; great
dyspnoea, with loud rattling in the throat, and the stethoscope
detected intense bronchitis in the left lung. On the 3rd the
tumor appeared above the clavicle, its stethoscopic phenomena
continuing the same. Thus he contined until the 6th, when he
had loud tracheal rattle, with increase of dyspnoea and dys-
phagia, the skin hot and dry, and the pulse 118, reeular. On
this day the bleeding was repeated, as before, with relief to a
certain degree, the stridulous breathing appearing only when
the patient coughed.
11th. All the bad symptoms are increaesd. The dulness
now extends over the antero-superior fourth of the right side,
the upper third of the sternum, and the sternal fourth of the
left clavicle. The tumor above the clavicle is about the size of
a hen’s egg, but of an irregular, crescentic shape, extending
from the fourchette of the sternum to the posterior border of
the clavicular insertion of the right sterno-mastoid, and for about
two fingers’ breadth above the clavicle. No alteration in the
stethoscopic phenomena, excepting that well marked pectorilo-
quy may be heard on applying the stethoscope to the anterior
portion of the tumour; intense bronchitis in the left lung.
From this period to the 17th he continued to lose ground ; the
stridulous breathing became constant, the voice shrill, and he was
occasionally aphonious. On this day we found the pulsation had
rather diminished, but the tumour was more diffused, and the
Diagnosis and Pathology of Aneurism. 411
dulness of the chest more extensive, occurring over the superior
thirds of the right side and sternum, and the internal third of the
left clavicle. The remaining portion of the right side, and the
whole of the left, excepting the sternal third of the clavicle,
sounds clear; respiration in the right lung exceedingly feeble ;
in the left, very puerile, and mixed with loud sonorous and mu-
cous rales. ‘The pain in the head continues. This has been a
very prominent symptom since he came into hospital. On the
20th the patient was still worse; there was oedema of the face,
particularly of the right side; loud tracheal rattle, stridulous
breathing, and occasional aphonia.
The whole of the right side now sounds completely dull, and
on applying the hand to the inferior portion while the patient
spoke, no vibration was communicated. The strong pulsation
continued with a loud double sound, both phenomena diminish-
ing in intensity as the stethoscope was approximated to’ the
heart, the impulse and sounds of which continue natural.
I concluded, from the occurrence of this dulness, that a se-
rous effusion had taken place into the right pleura. We ob-
served that during inspiration the right side dilated slightly,
but with great collapse of the abdomen; the right side of
the face became cedematous, as was also the paralytic arm,
while the right arm and lower extremities continued free from
cedema. ‘Ihe emaciation of the lower extremities was very re-
markable when contrasted with the upper. On the 27th, he
was moribund, The tumor had greatly increased, extending
as high as the thyroid cartilage, and being bounded on the left
side by the sternal portion of the sterno-mastoid muscle, and
on the right by the posterior edge of the corresponding muscle.
The tumor had pushed the trachea far to the left side, so that
the larynx corresponded to a line drawn from the angle of the
jaw to the middle third of the left clavicle. He sunk in the
course of this day. |
Dissection seven Hours after Death.—Head.—Nothing
remarkable on the external surface of the dura mater. About
412 Dr. Stokes’ Researches on the
four ounces of fluid escaped on dividing the membranes. Sur-
face of the brain rather paler than usual, but otherwise healthy
and firm. ‘The ventricles contained about half an ounce of
fluid. The right corpus striatum rather vascular, and apparent-
ly somewhat compressed, and situated nearer to the mesial line
than usual. On slicing the substance of the brain, an abscess
was exposed, situated about the middle portion of the right he-
misphere, commencing superior but external to the lateral ven-
tricle, and running downwards and forwards nearly parallel,
but having no communication with that cavity. The abscess
contained about an ounce of -thick white fiuid, resembling the
substance of the brain, softened and mixed with pus. ‘The sur-
rounding substance of the brain and external border of the cor-
pus striatum appeared rather softer than usual. The remainder
of the brain presented nothing remarkable.
Thorax.—Size of the external tumor much diminished. The
larynx, trachea, and cesophagus, which, previous to death, were
pressed over to the left side, and were situated nearly in a line
with the middle third of the clavicle, are now more in a line
with the sternal extremity of that bone. On dividing the in-
teguments, the cellular tissue of the neck and upper portion of
the thorax were found infiltrated with a yellow, gelatinous fluid,
the muscles pale and soft, and the cervical fascia much thickened.
The right lung was found collapsed, and reduced to a dark car-
nefied mass, in some meastire resembling the lungs of the foe-
tus. Strong adhesions between the two pleure, but evidently
not of recent formation, the pleura costalis bemg in some places
strong, opaque, and nearly the eighth of.an inch thick. - The
adhesions, however, were not complete over the surface of the
lung, but formed circumscribed sacs. These sacs were filled
with a straw-coloured serum, some containing from two to
four ounces. The left lung was very voluminous, and had
formed some slight adhesions to the costal pleura; it appeared
somewhat hypertrophed, and firmer than natural; its vessels
somewhat engorged, and the tubes filled with mucus. About
Diagnosis and Pathology of Aneurism. 413
two ounces of straw-coloured serum were found in the pericar-
dium. The heart presented on its anterior surface a yellowish
brown appearance, but was otherwise healthy. On slitting open
the aorta, it was found considerably diseased, somewhat dilated,
and the coats thickened ; the internal one uneven and nodulat-
ed, of a dull light red, speckled with yellow spots. This state
was most remarkable in the arch, but did not disappear from
the whole of the thoracic aorta. The aneurism was one of the
arteria innominata, the whole of the front of which artery was
destroyed, and replaced by the wall of the sac; the posterior
half, on the contrary, from its origin to its division, was sound.
The aneurism arose at first narrow, (two inches in circumference),
but gradually increasing in bulk so as to equal a large cocoa
nut, the walls being of irregular thickness, in some parts scarce-
ly thicker than paper. The finger, passed from the aorta through
the opening of the innominata into the sac, could feel the large’
fibrous and laminated coagula, with which it was in a great part’
filled. By its pressure it had so flattened the right side of the
trachea that the free margins of the cartilages overlapped those:
of the opposite side, and almost prevented the passage of air.’
The right carotid and jugular vein on the posterior surface of
the sac were flattened and obliterated, and contained firm coa-
gula. The vagus nerve also was flattened, and its fibres evi-:
dent and vascular. Both right and left ven innominate were’
flattened and completely obstructed on the anterior surface of
the tumor. The left carotid and subclavian arteries were unaf-
fected, but the right subclavian was pressed so flat at its imme-
diate origin, that no blood could have passed from the inno-
minata, though there appeared to have been a reflux current
from anastomosis, as the artery was gaping immediately after its’
origin, and quite healthy. From the pressure of the tumor
dewnwards, the apex of the lung was much compressed and
flattened. weN
I have been induced to give this case at considerable length,
as it illustrates so well the local, general, and stethoscopic phe-
VOL. V. NO. 15. 3H
414 ~ Dr. Stokes’ Researches on the
nomena of an aneurism of the arteria innominata, and as ac-
cutate stethoscopic observations of this disease are still de-
siderata in pathological medicine. ‘The complication, too,
with an affection of the brain gives the case an additional in-
terest. | |
I shal! now analyze briefly the symptoms of this case, and
connect them with the necroscopic appearances. It will be re-
collécted that for some time previous to the commencement of
his last illness he had been subject to attacks of hurried breath-’
ing after any considerable effort, and also a feeling of numbness
in the right arm. His last illness came on alter exposure to
cold, when he had pain in the head, neck, and upper part of
the right side, which last was aggravated upon any deep in-
spiration. He next got a short dry cough, stiffness of the neck,
sore throat, anda certain degree of dysphagia. It is difficult.
to say whether at this early period the dysphagia was produced
by the state of the fauces or the aneurismal disease. It is ge-
nerally taught that dysphagia, as a result of aneurism of the
aorta, or its immediate branches, occurs only when the tumor
has attained a considerable size. But a very small aneurism of
the aorta may cause dysphagia, of which I had a remarkable in- ,
stance some time ago in a case which has been published by’
my friend and colleague, Mr. Porter.* How far dysphagia
from a small aneurism of the innominata, might occur, is yet to
be determined. The. situation of the vessel would render this
less likely than in the case of the aorta. Under these circum~
stances, it is difficult to determine to which cause we are to at-
tribute the early dysphagia in this case.
How far the co-existence of stridulous breathing with dys-
phagia may be found to be a diagnostic between aneurisms of the
innominata or aorta in their early stage, is an interesting and
important question. It seems not improbable that in the for-
¥ See Dublin Medical Journal, vol. iv.
Diagnosis ani Pathology of Aneurism. ALS
anier case the co-existence of these two circumstances would be
more constant, the first pressure of the aneurism of the inno-
minata being exercised upon the trachea.
It will be recollected that this patient had cough, nt com-
plained of acute pain in the upper part of the right side of the
chest beneath the clavicle. Did this depend on the disease of
the innominata? It was observed that this pain was increased
‘by pressure, and by the patient taking ‘a deep inspiration, which
circumstances, connected with the discovery of frottement in the
sub-clavicular region, all tended to shew that the pain, in part at
least, was produced by pleuritic inflammation of the upper por-
tion of the right lung, a diagnosis which was made by Mr.
Power, who is an accurate stethoscopist and successful cultivator
of pathological medicine, and fully verified by the post mortem
appearances.
I may remark here that I had been for some so doubtful
as to the applicability of the test of frottement to the discovery
of dry pleuritis in the upper portions of the lung, but I have
now had so many cases as to leave no doubt that even in this
situation the motions of the pleura are sufficiently extensive to
cause the phenomena in question.
We have next to consider the paralytic attack which ona
vened on the night after his admission. It will be observed
that on the next day the patient had violent pain in the head,
with a varicose state of the veins of the neck. ‘The sudden oc-
currence of this paralysis, ina patient labouring under a mecha-
nical obstruction to the cerebral circulation, led at first to the
idea that its cause was an apoplectic effusion ; further conside-
ration, however, induced us to doubt this opinion: the paralysis
came on before the signs of venous congestion were well esta-
blished ; it was accompanied and preceded for some time by
violent pain in the head; and the patient stated to us, that for
some time previous to his last illness, he had pain in the head,
vertigo, tinnitus aurium, and flashes of light in the eyes, with
occasional numbness of the left arm and leg. | Here then, pre-.
416 Dr. Stokes’ Researches on thé
ceding the paralysis, were symptoms ofa cerebral affection; the
‘two circumstances in favour of apoplexy, being the suddenness
of the attack, and the existence of mechanical obstruction to
the circulation. Now, as to the first, it seems proved that sud-
denness of paralysis as a sign of apoplexy, cannot be depended
on, tinless where no premonitory symptoms of a local affection of
the brain have existed ; for we know that many cases of circum-
scribed abscess or softenings of the brain have occurred with a
sudden paralysis. In the next place, though venous congestion
may produce a circumscribed effusion, yet this lesion seems
more generally combined with an affection of the arterial than
of the venous system. In this case the cerebral symptoms and
their history, accurately corresponded with the lesion of the
brain found on dissection. |
Let us now consider the symptoms as connected with the
chest. One of the most remarkable of these, was the difference
of the intensity of respiration in the two lungs, the sound of
percussion of which was every where clear, except in the imme-
diate situation of the aneurism. This circumstance, arising from
the compression of one bronchus, seems to me a most impor-
tant one in the diagnosis of thoracic aneurisms, and one to
which sufficient attention has not been paid. In the case to which
I before alluded, published by Mr. Porter, this phenomenon
was well marked, and was in truth the only unequivocal sign of
any tumour existing in the chest: and there is at present a patient
in the hospital labouring under many symptoms of aneurism of
the aorta, though no external tumour is perceptible, and who
presents this sign in a most remarkable manner. When we
consider the difficulty that has hitherto been attendant on the
diagnosis of thoracic aneurisms, previous to the appearance of
tumour, any additional sign must be considered as of great va-
lue. Ihave no doubt that this one will in many eases prove
highly valuable. The observation too, may to a certain degree:
apply to the diagnosis between chronic laryngitis and the pres-
sure of tumours external to the tube ; for if, previous to the oc-
Diagnosis and Pathology of Aneurism. 417
currence of the stridulous breathing, this difference of respiration
has been observed in the lungs, a difference inexplicable by
any result of percussion or auscultation of the respiratory mur-
mur, it will give almost a certainty that the symptoms are not
the result of original laryngeal or tracheal disease, but of gra-
dually increasing pressure, first upon one bronchus, and aftere
wards on the trachea itself. |
In this case the phenomena, as connected with the aneurism,
were repeatedly and accurately observed, and the gradual ex-
tension of the tumour was measured with the greatest facility,
by the application of percussion. The aneurism presented all
through a double sound, perfectly analogous to that produced
by an excited heart, and without any bruit de souffiet or rape.
This double pulsation of aneurismal tumours has been already
noticed by several writers, and by some has been thought to
arise from the contact of the aneurismal tumour with the heart
itself, by which it receives its double impulse, an explanation
evidently inapplicable in the present case, as also in others
where the tumour has been at a still greater distance from the
heart, and totally unconnected with it. The occurrence of double
pulsations similar to those of the heart, seems to prove that the
action of a single cavity, may, under certain circumstances, pro-
duce a double sound, and hence it appears probable, that the
division of the heart into auricle and ventricle is not necessary
for its double sound. The explanation of the sounds of the
heart, founded on this division, must be reconsidered, and it is
not unlikely that mere systole and diastole of a single cavity,
or of two cavities, acting synchronously, as in the case of the
ventricles, with the entrance and exit of a fluid, are all that are
necessary for the production of the double sound.
There is a great deal of misconception abroad with respect
to the occurrence of bruit de souffiet, or other murmurs, as a _
sign of aneurisms; the truth is, that these phenomena are fre-
quently altogether absent, and we are in great want of facts to
explain their presence or absence in particular cases. I have
418 - Dr. Stokes’ Researches on the
‘observed their absence in aneurisms of all parts of the aorta. It
thas been supposed that the existence of pressure on the tumour
may be a cause, yet, in this case, although the tumour was evi-
dently winder considerable pressure ; no dislocation of the clavi-
cle having ever occurred, though the aneurism rose up considera-
ly, and pushed the larynx and trachea far to the left side ; the
sign was absent all through. It seems probable that the cause
of these phenomena, will be found to reside more in the state of
the vessel at its distal or its cardiac orifice, than in the mere exis-
fence of the aneurism itself, just as the murmurs of the heart
depend so commonly on the state of its orifices.
The last observation which I shall make on this case, relates
to the occurrence of the extensive dulness of the right side,
which occurred some days before death. It was almost certain,
from the absence’ of the stethoscopic phenomena of pneumonia,
that this was the result of a liquid effusion into the cavity of the
pleura ; and its having occurred when the patient was in a mori-
bund state, seemed to shew that it arose either from a hydrotho-
rax, or an effusion of blood from the aneurismal tumour itself. It
might be argued against the latter opinion, that an effusion of
blood to such an extent, must have produced instantaneous death ;
but sudden death from the rupture of aneurisms depends more on
the mode than on the quantity of effusion. I have already pub-
lished ‘cases illustrative of this in the fourth number of this Jour-
nal; inwhich quantities of blood, more than sufficient to have pro-
duced dulness and absence of respiration over one lung, were
effused within the body, and yet the patient continued to live.
In these cases, both of abdominal aneurism, the blood was ef-
fused behind the peritoneum, which it gradually detached from
its subjacent tissues, so that it was all through under the influ-
ence of pressure ; and in one of the patients, after these effusions
had been formed and recognized, sudden death took place by
another opening of the aneurism into the cavity of the pleura,
which was free from adhesions, and so permitted a sudden-ir-
ruption of blood. Now. in the case before us, a more or less
Diagnosis and Pathology of Aneivrism. 419.
adherent state of the pleura was to be expected, yet 1 determin-,
ed against the opinion that an effusion of blood had taken place,
from the force of the pulsations, and the volume of the tumour
not having been diminished; and consequently came to the con~
clusion, which was - verified by dissection, that a cadaveric hy-
drothorax had taken place. ;
Case II1.— Dilatation of the ascending Aorta.—Death by by
Rupture into the Pericardiwn.
_ Thomas Stafford, etat. 50, was admitted into. our wards on
the 18th of January, 1831. This patient, in the September’
preceding, i i consequence of a fall on his right side, experi-
enced for some time much pain in that situation ; in about a
month, however, he became affected with a sharp pain in the
superior portion of the left side ; ; this continued for about four
weeks, when he perceived a pulsation between the cartilages of
the second and third ribs, and from this time the pain in the:
chest considerably diminished. On admission a flattish tumor
was found. to exist, extending from the second to below the
third rib; this presented a double pulsation, closely resembling:
those produced by the action of an excited heart, and without
any bruit de soufflet or rape: he had no dyspnoea in the erect’
position, yet when he lay down he was immediately attacked
with difficult respiration. The stethoscopic phenomena of the
lieart and lungs were apparently natural. He was placed on a
low diet, bled generally and locally, and the infusion of digi-.
talis prescribed. Under this treatment he improved until the’
latter end of February; the double pulsation as observed by
the hand disappeared, but was always perceptible by ausculta-
tion. On the 23rd of February he was attacked with severe
pain in the chest, and numbness of the left arm, he could lie:
only on the right side ; by local bleeding and blistering some
relief was given, but he could not remain in the horizontal pos-:
ture for any length of time, from the exacerbation of the pain
thus produced. The double pulsation could be again plainly felt.
On the 26th he was bled ‘from the arm, with immediate relief’
420 Dr: Stokes’ Researches on the
of the pain in the chest and shoulder, and the numbness of the
arm ; he could now lie in the horizontal position ; thus he conti-
nued without any important change until the eleventh of April,
when, while sitting in bed, and talking to the other patients, he:
suddenly fell back, and immediately expired. 7
Dissection.—Body emaciated, no cedema; the mreme ee!
aorta was found greatly dilated, the dilatation commencing at
the semi-lunar valves, and terminating at the origin of the
innominata. The tumour was found adhering to the left side
of the sternum, and the cartilages of the second and third
ribs, and was about the size of a goose egg. This had rup-
tured into the pericardium, by a rent of about half an inch
in the anterior portion of the sac; the pericardium was dis-
tended with bloody serum, and on being opened, displayed a
vast coagulum of blood, occupying its posterior and inferior por-
tions ; no concentric laminz existed in the aneurismal tumour
the lining membrane of the thoracic aorta was studded with
bony depositions ; the heart was in 1 all respects heallaant and the
lungs perfectly crepitating.
In this instance we have an example of eee disease
of the aorta, (simple dilatation,) in which the phenomenon of
double pulsation was observed, and in which no bruit. de souf-
flet or rape existed at any period while the patient was under
observation. Here, from the situation of the. disease, it might
be supposed that the double pulsation was communicated from
the heart itself, but-we have already seen that this sign may occur.
under circumstances where the above explanation is imapplica--
ble. Imay also observe, that this case, like the last, is illustra-
tive of the accuracy of stethoscopic diagnosis, as relating to the
state of the heart, as well as that of the aorta: in both instances, |
the stethoscopic phenomena of the heart were natural, and the.
organ was found free from disease.
It may be an interesting subject for inquiry to ascertain, how
far the volume of the coagulum found in the pericardium, might
be considered as a measure of the diastole of the heart. At least
Diagnosis and Pathology of Aneurism. 421
a pound of blood existed in the sac: the suddenness of the
accident, and the immediate death of the patient, are opposed
to the idea that any gradual extension of the pericardium could
have taken place, at least to any extent. Under these circum-
stances, may we not conclude that that portion of space, if we be
permitted to use the expression, which would be occupied by the
heart in a state of distention, was filled by the sanguineous effu-
sion ; which thus may be supposed to equal the contents of the
hed! and any increase of volume which it may have during its
actions. ,
The next case I shall detail is an example of thoracic aneu-
rism, in which the sign of inequality of respiration was distinct-
ly observed.
Case [V.—Aneurism of the Thoracic Aorta, without external
Tumour ; recognized during Life.
Patrick Walsh, etat. 26, was admitted into my wards on
the 23rd of July, 1832, complainmg of cough and dyspnoea.
He had been subject for years to some cough, but this symp-
tom had been severely aggravated during the last ten days.
This patient was sent in as an ordinary case of bronchitis,
but I was at once struck with the peculiar appearance of the
neck. This was generally enlarged, (giving the idea of the
‘patient’s wearing a collar or tippet,) the jugular veins were
turgid and tortuous. No sign of cedema of the extremities,
or of abdominal effusion, existed.
He complained of short cough, with frothy, mucous expec-
toration, and of a stinging pain of the right shoulder, shooting
down to the mamma and frequently catching his breath. The
cough and dyspnoea were always worse at night, and his sleep
was frequently broken by frightful dreams. Pulse regular, 100,
rather smaller in the right arm.
The heart’s impulse was but slightly increased, yet its sounds
were heard loudly over a large portion of the chest ; on the left.
side some bruit de rape accompanied the first sound. The
VOL. v. NO. LS. oI
422 Dr. Stokes’ Researches on the
anterior portion of the chest was less sonorous than natural,
especially the right sub-clavicular region, which was decided-
ly dull. Posteriorly the chest sounded better. In the right
sub-clavicular region, the respiration was feeble, with a slight
mucous rale; in the right acromial region the respiration
had a tracheal character, while in the left lung the respiration
was puerile. On laying one hand over the right scapula,
and the other under the clavicle, a distant though. distinct
impulse could be felt, apparently synchronous with that of
the radial artery. No bruit de soufflet audible either under
the clavicles or in the acromial region. ‘The patient had some
dysphagia which dated from the commencement of the tumefac-
tion of the neck.
Connecting the existing symptoms with the history of the
case and the stethoscopic phenomena, I came to the conclusion
that this patient in all probability laboured under ‘an aneurism
of the arch of the aorta. The patient was treated by small
general and local bleedings, and in a few days was so much im-
proved that he requested to be discharged, declaring himself
perfectly. well. Before he left the hospital, I gave him a strong
warning against any excess, stating that it might be followed by
immediate death. A short time after this his former symptoms
returned. He entered another hospital in this city, where after
a few days he suddenly died while in the act of conversing with
some of the patients. On dissection an aneurism of the arch of
the aorta, which had produced death by rupture into the pleura,
was discovered.
The circumstance which first drew my attention particularly
to this case was the peculiar appearance of the neck. Here two
phenomena were observable ; one, the distended state of the
jugular veins; the other, the peculiar tumefaction of the neck,
giving the collar or tippet-like appearance to which I before
alluded. It is to the latter of these that I wish principally
to call the attention of my readers, inasmuch as it seems proba-
Diagnosis and Pathology of Aneurism. 423
ble to me that this appearance will be found a means of diag-
nosis between dropsy from pulmonary disease, and the tume-
faction arising from immediate obstruction of the vessels of
the neck. In this case, although the neck was so much en-
larged, yet it could scarcely be said to be cedematous, and
there was no proportion between the swelling of the neck
and that of the face ; indeed, after the patient had been treated
in hospital, any tumefaction of the face which existed on his ad-
mission, which was even then very slight, completely disap-
peared.
From the feel and appearance of this tumefaction, its cir-
cumscription, and occurrence without dropsical effusions in
other situations, I would look on it more as produced by a ge-
nerally distended state of the veins than by effusion into the
cellular membrane. In the case of Mears, this tumefaction
occurred first at the side corresponding to the aneurism of the
innominata, while in the case before us it was equal on both.
I shall not dwell long on the dilatation of the external jugu-
lars which was observed in this case and in that of Mears. In
the case of Stafford, the tippet-like tumefaction continued after
the swelling of the veins had subsided.
Can we, from any character of this state of the jugulars, ar-
rive at a knowledge of the seat, extent, or nature of the disease
which is a cause of the distention. Reynaud has already shewn
that the existence of an external collateral circulation, by which
the veins of the head anastomose freely with the intercostal, mam-
mary, and other superficial veins, may be considered as leading
to the diagnosis of obliteration of the superior eava, while the same
condition of the epigastric and other external abdominal veins,
points out obliteration of the inferior cava, or of the vena porta.*
* See Journal Hebdomadaire ; Dr. Graves on the Treatment of various Dis-
eases, Dublin Journal of Medical and Chemical Science, No. XII; Wright on
Cardiac Pathology, Philadelphia Journal.
4:24 : Dr. Stokes’ Researches on the
In the case of Mears the tumefaction and tortuosity of the ju-
gular vein was first observed on the side where the tumour ex-
isted, and afterwards, as it increased, the opposite jugular vein
became nearly similarly circumstanced. The state of the venze
innominate will sufficiently explain this.
I recollect a case of aneurism which was epee to be of
the subclavian artery, yet in which this state of the veins on both
sides existed during life. The result of the case shewed that
the inncminata was engaged ; so that it would appear, that in a
case of supposed subclavian aneurism on the right side, should
this varicose state of the jugular veins oz both sides occur, a
strong argument against surgical interference would exist; as
there would be almost a certainty either that the subclavian
aneurism was of great size, so as to compress both venee inno-
minatee, or that the disease was more deeply seated, and en-
gaging the aorta or innominata.
One of the most remarkable circumstances connected with
the symptoms and signs produced by the pressure of aneurismal
tumours on surrounding parts, is their remarkable variation, at
least in the earlier periods. This applies to the stridulous
breathing, the aphonia, the dysphagia, and the distention of the
veins. I want observations to prove that it also applies to the
partial feebleness of respiration ; but reasoning from analogy,
we have no reason to doubt the fact. This arises, m part at
least, from the varying size of these tumours, and the power of
adaptation in surrounding parts; and we might inquire, how
far in this circumstance of variation a diagnosis between aneu-
rismal and other organic tumours might be established. All cases
of solid intra-thoracic tumours should be carefully observed with
this view.
It will be observed, that in this case, the sign of inequality
of respiration in the lungs occurred in a remarkable man-
ner: to this subject I have already alluded in my observa-
tions on the case of Mears; and I shall now return to it as it
Diagnosis and Pathology of Aneurism. 425
seems to me an important addition to our means of diagnosis of
aneurisms of the thoracic vessels.
When an aneurismal tumour compresses either bronchus,
we observe a remarkable feebleness of respiration on the af-
fected side; this feebleness is general, when the main bronchus
is compressed, but I believe that it may be found more remark-
able in the upper or the lower lobes, according to circumstances.
Co-existing with this feebleness,; we have more or less puerility
‘of respiration in the opposite lung, while the sound on percus-
sion in the early period, at least, remains the same, and auscul-
tation can detect no sign as connected with the state of the pul-
monary cells or pleura, to account for the phenomenon in ques-
tion. In the early periods we have still some respiratory mur-
mur, but as the tumour increases in size, this becomes extin-
guished, and we have a tracheal respiration and dulness of
sound in proportion to the extent of the tumour, and at this pe-
riod the other signs and symptoms of aneurism are commonly
developed. I do not put this observation forward as leading
us to any certain diagnosis of intra-thoracic aneurisms ; like all
other morbid phenomena it has no value, except when connect-
ed with other circumstances ; indeed, we may say, that in me-
dicine there is no one sign or symptom, which, taken alone, can
be considered as pathognomonic. We know that other cir-
cumstances, besides aneurisms, will cause an inequality of respi-
ration in the two lungs, without difference in the sound on per-
cussion. Thus in the Clinique Medicale of Andral, “ Maladies
de Poitrine,” we read of a patient who presented a loud respira-
- tion in the left lung, while that in the superior portion of the
right was much more feeble; percussion on both sides giving
the same results. The patient stated that for a length of time, he
had experienced a kind of constriction above the right breast,
and declared that he did not breathe with the right side of his
chest; this patient presented the phenomena of organic disease
of the heart, and died with symptoms of hydrothorax. Upon
dissection, the superior lobe of the right lung, though little
426 Dr. Stokes’ Researches on the
crepitating seemed otherwise healthy, but its principal bronchus,
at a few lines from its origin, was so contracted as hardly to
admit the passage of a fine probe. This contraction was owing
to thickening of the mucous membrane, and explained the par-
tial feebleness of respiration. ‘The heart was in a state of ac-
tive aneurism, and the aorta narrowed.
In the same volume, a case is recorded of a patient who la-
boured under chronic bronchitis, with copious puriform expec-
toration, the respiratory murmur over the left lung was very in-
tense, while on the right it was much more feeble, the sound on
percussion being equal. On dissection, the root of the right lung
was occupied by an enormous mass of melanosis, which seemed
to have arisen from the bronchial glands, which were so involved
in the tumour, as to be undiscoverable; the right bronchus was
comprised in this mass, and so compressed, that its calibre was
not more than half that of the bronchus of the other lung.
The other causes which might produce the sign under con-
sideration, are the existence of a foreign body in one bronchus,
and a partial emphysema ; but, notwithstanding that the sign of
inequality of respiration, without dulness of sound to account
for it, may arise from these several causes ; it is yet plain that
its existence in any suspected case of aneurism of the aorta, will
be an important circumstance, and that in any case where it
does occur, we must, in seeking for its explanation, take the
possibility of aneurism into consideration ; and let it be recol-
lected, that of all the causes competent for its production, this
is the most frequent. It is obvious that the history of the case,
and the period of duration of the symptom, will be of the great-
est consequence in determining this question.
Although cases of aneurism of the abdominal aorta, in which
the nature of the disease was not suspected before death, have
been described by many authors, still it is of importance to add
to our stock of knowledge on this subject. For the notes of the
two following cases, I am indebted to my friend Dr. Frazer, a
gentleman of great experience in military surgery.
Diagnosis and Pathology of Aneurism. 427
“Case V.—A native of India, in the pioneer corps of Ceylon,
employed as a labourer in road-making, had an accession of
symptoms of severe colic in the year 1823. The same symp-
toms having several times previously compelled him to abandon
his work, and to seek refuge in an hospital. Treatment and
short repose enabled him to resume his occupation. On the
day of his last admission, the urgency of the symptoms was re-
lieved, but on that subsequent, an excruciating recurrence of
them took place, and in about half an hour ended suddenly in
death.
“Dissection, three or four hours after death, showed a
great effusion of blood in the belly, the intestines being in fact
deluged with the quantity; it proceeded from the bursting of an
aneurism, the size ofan orange, situated in the abdominal aorta.
The real disease in this case was never even suspected.
“Case VI.—A British soldier came into hospital, complaining
of violent pain in his back, particularly along his spine, no ac-
companying morbid signs, either local or constitutional, being
indicated. His health was good, the natural and vital functions
seemed to be regularly performed: there was no emaciation.
Leeches, and I believe some other remedies, were used during
his stay in hospital; on his dismissal he acknowledged him-
self relieved. On attentive consideration of the case, suspicion
lurked in the minds of the medical attendants, that the case
was either feigned or was unimportant; symptoms both local
and general being still absent, when he returned a second time,
asserting the aggravation of his complaint. After some resi-
dence in hospital, he was again discharged without any conclu-
sion having been arrived at as to the nature of the case. The
two medical attendants. (both experienced in the service) were
perplexed, though inclined to believe that the man fabricated
much, On his last return to the hospital, he was met by one of
the above gentlemen, and to the question, what was the matter
with him, the invalid replied, “ Oh, sir, I can bear it no longer,
T must come to hospital.” In about three or four hours this
428 Dr. Stokes’ Researches on the
gentleman was shocked and confounded by hearing of the death
of the patient.
« On examination a large aneurism of the abdommal aorta
was found ruptured, the bodies of the adjoining vertebra were
carious. The surgeon of the regiment to which this man be-
longed, was a cautious person, and fortunately for himself,
though he suspected the reality of the disease, avoided those
measures which the false conclusion, that the hapless soldier
was an impostor, might have led him to adopt.
« Case VIL.—Aneurism of the Abdominal Aorta opening into
the left pleura. |
« A gentleman, aged about 30, who had previously enjoyed
good health, was attacked in the latter end of the year 1830,
with symptoms of deranged bowels, followed by obstinate and
permanent constipation, for which he used much purgative me-
dicine with but little relief; he then began to complain of a
sensation of uneasiness and oppression referred to the left side,
and a feeling as of a tumour in the left hypochondrium extend-
ing to the groin; he had also weakness and pain in the back.
The disease was first considered to be an affection of the intes-
tinal canal, then psoas abscess, and lastly disease of the kidney.
These distressing symptoms increased, and about three months
before he consulted me, a pulsating tumour appeared in the
postero-inferior portion of the left side, which soon became of
great size. ‘The disease was now treated as aneurismal, and
the patient placed on an exceedingly low regimen, but his suf-
ferings from pain and oppression continued to increase, and
were frequently so intolerable as to make him long for death.
On one oceasion, in a fit of despair, he entered a tavern and or-
dered a sumptuous dinner, of which he partook heartily ; he drank
a pint of wine and two tumblers of brandy punch ; this was fol-
lowed by an immediate cessation of his distressing symptoms,
and he continued quite free from pain for many days, and en-
joyed a state of comfort to which he had been a stranger for
months. From this time he generally lived well, as he uniform-
Diagnosis and Pathology of Aneurism. 429.
ly found that any return to low: diet brought on an iticrease of
his distressing symptoms.
When he came under my care he was pale, Baiarnteck ia
had a miserable expression of countenance, indicative of suffer-
ing and despair ; he referred all his sufferings to the left hypo-
ehondrium, where he declared there was a large tumour, which,
however, after the most repeated and careful examinations, I
was unable to detect, although the part had a certain degree of
fulness. Posteriorly, from the short ribs to nearly the apex of the.
scapula, a vast pulsating tumour existed, the pulsations of which
were so violent, and the coverings apparently so thin, that I was
in daily apprehension of his sudden death while under examina-
tion. Notwithstanding this, the action of the heart was feeble,
and although the patient used to walk to my house, (upwards
of a mile and a half,) yet on his arrival his pulse or respiration
was scarcely accelerated, nor his sufferings in any way increas-
ed. About a fortnight before his death he laboured under
some excitement, with considerable increase of oppression, and
I ventured on taking about six ounces of blood from the arm.
The blood was poor and watery, and he bore the operation
badly. Soon after this the belly became swollen, the oppres-
sion dreadful, the countenance assumed the hippocratic expres- -
sion, and for the week previous to his death, he laboured under
atrocious colics. During this period I detected for the first
time a diffused bellows’ sound in the left hypochondrium, very
similar to that of the placentary murmur, and on the day pre-
vious to his decease a pulsating tumour could be felt in this
situation. |
Dissection.—The body was emaciated, with large eechy-:
moses on the back; an enormous fluctuating tumour extended
from below the left scapula to the last rib, the left side was’
considerably dilated, the intercostal spaces obliterated, and the:
sound on percussion completely dull ; belly tympanitic. Veh
The left: pleura was filled with a vast coagulum of blood,
and its separated serum; this had almost completely com-
VOL. v. NO. 15. 3K
430 Dr. Stokes’ Researches on the
pressed the lung, which did not descend below the third rib ;
the heart lay at the right side of the sternum. On remov-
ing the coagulum we observed that on its upper portion some
separation of fibrine had occurred. The pleura was found red,
and generally covered with a thin layer of lymph. In the lowest
portion of the pleural cavity we perceived the ruptured aneu-
rismal sac displaying its concentric layers of coagulable lymph,
which hung in irregular masses in the cavity of the pleura; the
sac was found to be of great size, extending inwards and down-
wards until it reached nearly on a level with the crest of the
ilium, its chief protuberance being to the side of the abdomen :
five of the vertebrae were deeply eroded, and two of the left
transverse processes were found: completely detached and enve-
loped in the coagula. The intervertebral cartilages seemed per-
fectly sound, and were of a pearly whiteness; the left crus of
the diaphragm was destroyed and the muscle partly enveloped
the tumour in the form ofan arch ; no effusion of blood into the
sub-peritoneal tissue on the lateral or anterior portions of the
parietes had oecurred, nor were the psoa or iliac miuscles en-
gaged. The’ heart was exceedingly flabby, shrivelled, and of a
livid hue, an appearance strongly contrasting with that of the
external muscles, which were red and firm ; the aorta seemed
perfectly healthy until about three inches from its bifurcation,
where a well defined oval perforation of the posterior surface
existed, which communicated directly with the sac. |
I have inserted this case principally with the view of draw-
ing the attention of medical men to: the investigation as: to how
far the treatment of Valsalva is applicable to aneurisms: of the
aorta.
The case before us exemplifies what has been observed in
many other instances, that a low regimen seems to imcrease the
sufferings and accelerate the progress of the disease in patients
labouring under aortic aneurisms. On this subject Bertin makes
the following remarks :—“ Valsalva et Albertini au rapport de
Morgagni, ont obtenu la guérison dun grand nombre d’anéy-
Diagnosis and Pathology of Aneurism. 431
rismes tant internes qu’externes, par l’emploi rigoureux du
traitement qui porte leur nom. . Morgagni lui méme, Lancisi,
Guattani, Sabatier, MM. Pelletan, Corvisart, Hodgson, Laen-
nec, &e. &e., recommandent cette méthode et citent des faits
en sa faveur. Nous partageons leur opinion a cet égard, mais
nous avouons que s'il est bien démontré qu’elle a été suivie des
plus heureus succés dans le traitement des anevrismes externes,
il n’est pas aussi rigoureusement prouvé qu’elle ait réussi le
plus souvent dans celui des anévrismes de l’Aorte bien reconnus
pour tels, et nous pensons que la plupart des cas rapportés par
les anteurs sont des exemples de guerison d’aortite pure et
simples ou d’anevrismes simulés,
In the case recorded by Dr. Beatty in the 5th vol. of e
Dublin Hospital Reports, great alleviation of the distressing
symptoms followed the change from a low regimen to a more
generous diet. The same circumstance was observed in Dr.
Proudfoot’s case, published in the Edinburgh. Medical and.
Surgical Journal, and in the Report of the Meath Hospital, by.
Dr. Graves and myself; where we suggest that this circumstance
may be explained by supposing that in consequence of the use: of
nutritious diet a more coagulable blood is formed, and thus the
extension of the disease for the time suspended. I have my-
self seen within a short time three cases where the most marked
relief followed the change from a low to a generous diet. It is
plain that the question is still an open one, but that in the
treatment of any case of aortic aneurism, two circumstances
must be kept in view, one the degree of excitement of the heart
itself, and the other the state of the blood.* Of course the
case in which no disease of the heart exists will be the most
favourable for treatment ; and it is fortunate that in many cases
of recognized: aneurism of the: aorta, the healthy or diseased
state of the heart can be accurately determined during life.
In this case the pulsations of the vast tumor might well be
ie ane eh ete ee arin A SAY 1G OU ae
* See Piorry, Journal Hebdomadaire ; Hope, Diseases of the Heart.
432 Dr. Stokes’ Researches on the
called terrific, and yet the heart was found small, flabby, and
shrivelled. The explanation of the great force of aneurismal
pulsations seems as yet far from being cleared: up. Some have
explained it by supposing a hypertrophy of the left ventricle :
yet it may occur, as in this case, with the very opposite state of
the heart. Others conceive that it arises from the co-existence
of aortitis, an explanation which might apply to the case of true
aneurism, but not to that by perforation, where the whole sac
pulsates violently.
It appears to me that much of this violence of pulsation is ex-
plicable by the common law in hydrostatics, that a given pressure
exercised on a fluid confined in a vessel is communicated to every
portion of the surface of that fluid, and thence to the parietes
of the vessel, and thus multiplied. In fact we may draw a close
analogy between the hydraulic press of Bramah and the case of
a heart acting upon an aneurismal tumour of the aorta, which
contains a quantity of blood, and thus arrive at an explanation
of its enormous pulsations; of course the effect will be dimi-
nished or modified by the quantity of coagula, the elasticity
of the sac, and the means of exit of the fluid. I need hardly
remind the reader, that it is during the diastole of the tumour
that the violent pulsation is felt, a point strongly bearing on the
explanation of the impulse of the heart itself.
- [| have now great pleasure in inserting the following com-
munication, with which I have been kindly favoured by Pro-
fessor Harrison, on the subject of Arterial Pathology. When
we consider its source any observations on its importance would
be superfluous :
a «* January 6th, 1834, 1, Hume-street.
« My Dear STOKES, yA
«“[ hasten to reply to your note I
have just received, in which you request me to convey to you
in writing certain remarks on thoracic and abdominal aneurisms,
the substance of which I lately communicated to you in rather
a desultory conversation. |
“Tn alluding to the pain, among other symptoms attending
Diagnosis and Pathology of Aneurism. 433
internal aneurisms, I have remarked, that although it is very.
frequently stated that the degree of suffering attending thoracic
aneurism is trivial, when compared with that complained of im.
a similar lesion of the abdominal aorta; yet exceptions not un-
frequently occur. Thus, I have known cases of aneurism of the
arch of the aorta to have been accompanied almost through
their entire course with intense, though often intermitting pain
in the region of the heart, in the spine, or through the chest.
generally, or in one or both arms; while, on the other hand, I
have seen instances of this disease in which the suffering was
so trivial, and the symptoms were so faintly and equivocally ex-
pressed, that the disease was not ascertained until the post
mortem examination revealed its real nature. In forming our
diagnosis, then, in suspected cases of thoracic or abdominal |
aneurism, too much importance or reliance is not to be placed
on the mere circumstance of pain being either slight or absent,
or intense and of almost continued duration. The change in a
blood-vessel denominated aneurism is of slow progress, and un-
attended by acute inflammation ; the arterial tissue, though pe-
culiarly organized, is not very sensible to pain, or subject to
acute disease, therefore aneurism is not painful yer se, but only
in proportion as the tumour may interfere with some adjacent
organ, or excite irritation in some contiguous sensitive structure.
Thus aneurism in the arch of the aorta may disturb the action
of the heart, or may irritate the trachea, or by extending, com-
pressing or in any way disarranging the neighbouring nerves,
such as the left recurrent, the phrenic, or the cardiac plexus,
may give rise to severe paroxysms of pain, both local and re-
mote ; yet in other instances of disease in nearly the same situa-
tion, the tumour may so shape its course as to steer clear of
any interference with surrounding objects, and thus avoid all
excitement or irritation, or even interruption, to their functions,
except so far as the latter may be impaired: by the anormal
condition of a vessel whose integrity must be so very essential
to the existence and well being of the economy at large. The
434 Dr. Stokes’ Researches on the
same remark may apply to aneurism of the thoracic aorta in the
posterior mediastinum ; the tumour in some cases proceeds through
all its stages to its fatal termination, without much accompany-
ing local pain, or decided premonitory indications, whereas in
other cases, acute spinal irritation, difficult and painful respira-
tion and deglutition, are almost constant concomitants: attention
to the anatomical connexions of the vessel in this situation,
and to the different directions it may take in different instances,
may explain the variety of symptoms that present in different
cases.
- «The abdominal aorta is in connexion with several impor-
tant organs through its whole course ; it is also invested in ¢hree-
fourths of its circumference with a plexus of nerves, branches
of which extend along the different arteries to the several viscera.
All the visceral arteries are remarkable in this respect, but more
particularly the renal, gastric, and hepatic ; one continued ner-
vous network surrounds each from its origin to its final distri-
bution. From these circumstances, we should expect that
aneurism of the abdominal aorta, or of its branches, should be
attended with much pain and functional derangement ; and such
is generally, but not uniformly, the case. I have witnessed the
dissection of three cases of large aneurism which had burst be-
hind the peritoneum, and which, during life, had not been at-
tended with much pain, or with any decided symptoms which
could lead to a positive diagnosis. In each of these the tumour
was connected with the posterior part of the artery ; in one case it
was situated close to the diaphragm, and the blood was partly
injected into the posterior mediastinum, and partly into the
abdomen, about the pancreas ; in the second case, the tumour
had burst into the cellular tissue round the kidney ; and in the
third case, the symptoms had been during life so similar to
those of psoas abscess, that uncertainty as to the true nature of
the disease occasionally existed. (See Surg. Anat. of the Arteries,
vol. i. p. 25.) Although I have not sufficient facts before my
mind on which to ground the assertion, I should yet consider
Diagnosis and Pathology of Aneurism. 435
that when aneurism arises from the forepart of the abdomi-
nal aorta and extends into the cavity, pain, and more or less
disturbance of the adjacent viscera, will be more likely
to oceur. ‘The stomach I have remarked to sympathize ex-
tremely in these affections ; hematemesis has frequently occurred
during their progress, and in one case death immediately fol-
lowed a copious vomiting of blood, which must have been sup-
plied from the capillaries of this viscus, as the ancurismal sac
had no communication with it, and had poured its contents in
a totally opposite direction.
“In speaking of abdominal aneurism, J am led to another
remark which appears to me to present some interest, namely,
that in the abdomen we frequently meet with aneurisms of the
smaller arteries, not merely the cceliac axis, or the mesenteric,
but of the gastric, splenic, hepatic, &c. I have seen examples
of each of these. I also recollect a remarkable case, in which,
on opening the abdomen, I was surprised at the livid colour and
great size of the omentum ; it was injected with grumous
blood, from the arch of the stomach to near the lower border of
this process. On careful examination I found it had proceeded
from an aneurism of the left gastro-epiploic artery ; the tumour
was about the size of an egg, and had given way by a sort of
slough between the layers of the gastro-colic omentum ; the
surrounding parts were slightly thickened, but the stomach was
free from disease, as was the peritoneum from inflammation.
In the Museum of the College of Surgeons there is a specimen
of aneurism of the coronary artery of the stomach. I have seen
one case of aneurism of the right hepatic artery, including the
root of the cystic; the tumour had not opened; the patient
died of dropsy and disease of the heart ; the gall bladder was
shrivelled and empty. I have dissected a case of large splenic
aneurism which caused death by bursting behind the perito-
neum: the spleen was unusually small. Many years ago I saw
an aneurism of the right spermatic artery about an inch distant
from the aorta; the testicle was of the usual size, and appa-
436 . Dr. Stokes’ Researches on the
rently healthy ; the tumour was about the size of a nut, and had
not caused any injury to the surrounding parts, though it is pro-
bable, had the individual lived for some time, it would have
proved fatal by bursting. In the course of last winter, I acci-
dentally found in the dissecting room an aneurismal tumour on
the left renal capsular artery ; the subject was a female, about
eight or ten years of age; the tumour was solid to the feel, and
on cutting into it was found filled with successive laminee of
fibrinous matter; very little cavity remained, so that the dis-
ease might be considered as undergoing a natural or spontane-
ous cure. Although aneurism is a disease common to all parts
of the vascular system, yet it is certainly very seldom found in
any of the external arteries, except the principal trunks, such as
the éarotid, axillary, iliac, femoral, or popliteal. I do not re-
collect any case of spontaneous aneurism in any of their smaller
branches, though suchare not unfrequent consequences of wounds
or injuries ; even in an artery of the size of the brachial, spon-
taneous aneurism is very rare. In the cranium it has been met
within the internal carotid, and in some of its primary branches;
+t lias been also found, but very rarely, in the coronary arteries
of the heart. It might prove an interesting inquiry to consider
why the. small arteries of the abdomen more frequently present
this disease than arteries of a similar size do in any other situa-
tion. Is the cause of this fact to be found in any peculiarity of
structure, of course, of connexion, or in function? probably on
each of these circumstances it more or less depends. As to
structure, the abdominal arteries are certainly very weak, par-
ticularly their middle coat ; hence their great liability to rupture
in the common process of injecting the dead body. As to
course and connexion, no vessels in the body are more remark-
able for numerous turns, angles, flexuosities, &c., and most of
them run very much unsupported, except by the general pressure
of the parietes of the abdomen. In function, too, many peculiari-
ties present themselves to our attention which may serve to ex-
plain the frequent occurrence of this disease in the abdomen, “as
Diagnosis and Pathology of Aneurism. 437
well as the great liability of the mucous surface of the alimen-
tary canal to severe and frequent hemorrhage: thus, the quan-
tity of the blood circulating through this cavity must be very
considerable ; the active function that is so Srequently exercised
in different parts of the apparatus must require a proportional
supply of blood, so that increased vascular actions must constant-
ly occur in different situations and in rapid succession. The
very remarkable freedom of anastomosis between the several
vessels may probably be designed to facilitate the more rapid
course of the blood from one organ to another, according as the
respective functions of either may require it. The irritability of
the small vessels may be inferred from the great supply of nerves
with which they are furnished. I have not sufficient facts be-
fore me to decide on the pathology of these small abdominal
aneurisms. I have not observed any diseased condition of the
coats of the vessel in the vicinity of the tumour, so common-
ly observed in thoracic aneurisms. From the observations I
have made, which, however, are insufficient, I consider that
they commence by rupture, and not by dilatation of the internal
funics. |
“Yours very truly,
“* Ropert Harrison.”
Among the many interesting and important subjects alluded
to in this letter, there isnone more interesting than the explana-
tion of the comparative frequency of aneurisms of the internal,
as compared with those of the external arteries of the body. I
have long thought that this was to be explained by a reference
to the sympathies of arteries with organs.
If we look to the viscera we see numerous parts and sepa-
_ rate organs constantly performing various functions, and liable
to separate physiological and pathological excitements, while
the system of voluntary muscles, in the first place, represents
a single organ, is often at rest, and is composed of a tissue but
little liable to inflammatory disease. Hence, in part at least,
VOL. Vv. No. 15. ool
438 Dr. Stokes’ Researches on the
the comparative rarity of disease in its minor arteries, alluded
to by Professor Harrison.
This leads me tonotice a species of arterial throbbing either
in the abdominal aorta itself, or, as has been suggested by my
friend, Dr. Houston, in the second order of vessels, which has
not yet been described.
Asa sign of diseased action, throbbing of the abdominal
aorta has been long recognized. But its nature in all cases
does not seem to have been discovered. It has been described as
a nervous phenomenon; as the result of the pressure of tumours
‘on the vessel, and as a symptom of aortitis. It may also be seen in
cases of great retraction of the abdomen. But there is a pulsa-
tion of the abdominal aorta or its immediate vessels, which is
symptomatic of inflammatory disease in the digestive system, and
which a long experience enables me to say may be considered
an important assistance in diagnosis. A throbbing generally
commensurate with the disease ; removed by treatment calculated
to relieve enteric inflammation, and aggravated by every thing
which will increase this affection. In other words, we may have
from enteritis or peritonitis a throbbing of the abdominal aorta
or its vessels, perfectly analogous to the morbid action of the
radial artery in whitlow, or of the carotids or temporal arteries
in cerebritis.
The cases in which I have most frequently observed this
symptom, are those of the gastro-enteric fever of this country ;
and when we reflect on the latency of the follicular ulcerations
of the intestine, and the great number of times that this lesion
is overlooked, and exasperated by improper treatment, we
must see of what importance the knowledge of any prominent
symptom must be. Ido not say that it occurs in all cases, such
is far from the fact ; but I know that it occurs in many, and
may be made a great assistance in diagnosis.
I have also found it in cases of fever after corrosive poison-
ing, where the pulse was almost absent at the wrist ; and in pe-
ritonitis, where no pulse could be felt.
Diagnosis and Pathology of Aneurism. 439
In these cases we have frequently the following group of
circumstances: fever, prostration, thirst, tenderness of the epis-
gastrium or the ileo-coecal region. The pulse at the wrist is
often small and feeble, while the abdominal pulsations are com-
paratively violent. In most cases the other symptoms of gastro-
intestinal disease are sufficiently plain. But in several instances
this want of proportion between the action of the radial, and
abdominal arteries, combined with fever, has been the principal
indication of enteric disease.
As might be expected, the increased action may extend to
the femoral arteries. This fact enabled me on one occasion to
arrive at an accurate diagnosis. A patient who had been sub-
ject to chronic disease of the stomach, was brought into hospital
ina dying state. Something, he said, suddenly gave way within
him a short time before admission. His countenance was col-
lapsed ; the hands blue, and no pulse could be felt at the wrist.
The belly was swelled, but not very tender.
It was suggested that the case might be a rupture of an ab-
dominal aneurism ; others supported the opinion that it was an
example of peritonitis by perforation: and that the latter diag-
nosis was the right one, I concluded from the fact, that while
no pulse could be felt at the wrist, the femoral arteries at the
groin were pulsating strongly. Recollecting also that the pa-
tient had laboured under symptoms of chronic gastritis, and
that the feeling of giving way was felt first in the left hypochon-
drium, I concluded that the case was one of peritonitis from a
perforating ulcer of the stomach. On dissection an old circum-
scribed ulcer of more than an inch in diameter, was found in
the greater curvature of the stomach. This had perforated
the peritoneal coat by an irregular rent. The aorta was heal-
thy.
In some cases we have found that the pulsation was strongest
in the direction of the right iliac artery, and subsided with the
symptoms of the gastro-enteric fever. We have seen it with and
without the occurrence of diarrhoea, and frequently reappearing
440 Mr. L’Estrange’s Description of the Caleulo Fractor
with relapse, particularly after errors in diet, or hypercatharsis.
In some instances it has subsided when the diarrhoea appeared,
and returned on its being arrested by an astringent.:
The knowledge of this sympathetic pulsation of the great
vessels of the abdomen may throw light on the supposed cures
of internal aneurism, by the system of Valsalva. It must be
recollected that the cause of this pulsation (which is often vio-
lent) is most frequently a local inflammation of some part of the
digestive system; in other words, an affection likely to be
relieved by such a mode of proceeding. Indeed the suggestion
of Bertin, that some of these cases were not really examples of
aneurism, seems at least so far, highly probable. Experience
seems to show that in many cases a low diet aggravates the
symptoms of large internal aneurisms ; and if the explanation
which I have given of their violent pulsations be correct, we can
easily see that, the more fluid be the contents of the aneurismal
cavity, the greater will be the impulse from the hydrostatic
pressure: of course this would act in extending the sac, and,
consequently, injuring the surrounding parts. In the cure of
aneurisms, the subsidence of the impulse is one of the first and
most important signs.
Art. XXV.— Description of the Calculo Fractor for Pulveriz-
ing the Calculus in the Bladder. By Francis L’EstrancE,
A.M., M.R.C.S. I., Dawson-street.
From the earliest ages it appears to have been a desideratum
in surgery to discover some means whereby the dangerous ope-
ration of lithotomy might be rendered unnecessary ; thus we
find various preparations at different times tried and extolled
for their supposed solvent powers. It does not seem, however,
that the grand object in view was destined to be attained until
modern invention should contrive the expedient of breaking up
the calculus in the bladder, and having the detritus subsequent-
for Pulverizing the Calculus in the Bladder. 44]
ly washed out through the urethra. It would be quite super-
fluous to draw a comparison here between lithotrity and litho-
tomy, that has already been ably done by the different gentle-
men who have written on the former operation.* Still it must
be admitted, that however good the principle, yet in practice
this operation has been found to labour under many defects.
For example, with Baron Heusteloup’s “Percuteur,’ which,
taken altogether, appears to be the most perfect of the instru-
ments as yet used for this purpose, there is almost a certainty
of the instrument, or stone held by it, or both, being driven
by the hammering against the sides of the bladder, and thus
causing incalculable mischief. So great a defect has this
been found, that to obviate it a bed has been constructed,
and the patient being fixed thereon, the percuteur is intro-
duced and fastened to an iron bar placed in front for that
purpose; the staff is thus certainly rendered almost immove-
able, but as the patient cannot be equally well secured, and as the
slightest motion on his part, might cause as great or even great-
er mischief, the object seems to be as far as ever from being
accomplished. Nothing is here advanced against the inconve-
nient unwieldiness and great expense of such a complicated sys-
tem of instruments, beds, &c. Again, the detritus of the calcu-
lus, by lodging between the curved blades of the instrument
prevents their closing, and thus increases, in some instances, con-
siderably, its diameter; this, in all cases, must cause extreme
pain on the withdrawal of the instrument, and has in particular
instances produced laceration of the parts and hemorrhage.
To do away with these and other objections, the instrument, of
which sketches and a description accompany these remarks,
has been invented. Its advantages are extreme simplicity ;
it bemg acted on by a screw of such power as to pulve-
* Vide Lithotrity, Lancet 1829, 30, 31; Lithotrity and Lithotomy com-
pared. T. King, M. D., 1832.
442 Mr. L’Estrange’s Description of the Calculo Fractor
rize any calculus found within the bladder, thus doimg away
with the dangers of percussion; a stillette, which passes
in a groove between its blades, by which the detritus lodg-
ed there can be at once removed; a claw fastened on a
pivot to the screw, so as to allow of its being fixed at will to the
upper blade of the instrument, which can then, by turning the
screw backwards, be separated without the slightest shock from
the inferior one, should these have become agglutinated by the
broken down calculus and its animal mucus. Finally, should
any case occur, or any individual still prefer the operation with
the hammer, by removing the vice this can be performed
as heretofore, the operator enjoying the additional advantage
of the stilette. There are many other desirable qualities
that might be enumerated as possessed by this instrument ;
but it is not intended to trespass at present any further on
the reader’s time ; suffice it to say in conclusion, that there
are but two cases requiring the operation of lithotomy to which
it is not applicable, namely, a calculus contained in a pouch, or
a bullet in the bladder.
EXPLANATION OF THE ANNEXED PLATE.*
Fic. 1. Represents the instrument as in the act of being closed by
the power of the vice, the point of the screw playing in a socket
at the extremity of the handle, which causes direct pressure
downwards, without producing any rotation whatsoever at that
portion of the instrument in the bladder, and thereby preventing
any injury being done to the mucus membrane of that organ.
* The Medal of the Royal Dublin Society was awarded for this Instrument.
The operation with the Calculo Fractor was performed this day (June 4th), with
complete success, by the Surgeon General, (there were present also Surgeons
Adams, Hargrave, and Smyly,) the peculiar advantages of this Instrument having
been exemplified in a remarkable manner.
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Jor Pulverizing the Calculus in the Bladder. 443
Fic. 2. The vice, having a screw, with a double thread. The weight
of this portion of the instrument is an advantage to the operator,
by enabling him the better to keep steady the instrument, while
this part is grasped in his left hand, which is to be supported
on his left knee, the foot being placed on a low stool in the posi-
tion for operating.
Fic. 3. The claws of the instrument open their wedge-like teeth well
adapted for splitting, also the detritus rod scraping the bottom
groove, So as to remove all particles of the broken stone that
always remain preventing the claw from being closed, and thereby
causing great laceration of the urethra and hemorrhage.
Fic. 4. The box of the instrument, the handle of the upper claw in
which the socket for the screw to play in is placed, also the canal
for the detritus rod.
BIBLIOGRAPHIC NOTICES.
An Introduction to Botany.. By Joun Linptiey, lf’. R.S. 1.8.
G.S., Member of the Imperial Academy Naturze Curioco-
rum, Professor of Botany in the University of London.
With Six Plates and numerous Wood Engrayings. Lon-.
don: Longman, &c. 1832. pp. 557. 8vo.
Every one knows that there are two qualifications in a scientific
work which should influence both the author in undertaking it,
and the public in the reception of it, first, that it should be a
desideratum, and secondly, that the desideratum should be well
supplied ; if deficient in either of these it cannot expect the
privileges attending a literary work, of making up for defect in
matter by excellence of style, but must remain an useless and
unnecessary addition to the heap that obstructs the student’s
path towards the attainment of knowledge, which should be ac-
quired with the least possible waste of time and words. Under
both these points of view we shall consider Professor Lindley’s
work, as they are equally applicable to botany as to all the phy-
sical sciences, so long as any investigations remain to be made,
and consequently any thing new remains to be taught.
The greater part of our knowledge, both of the natural affi-
nities of plants and their organic structure, has been furnished
not by the general botanist, properly so called, but by those
who have devoted their attention to the habits and characters of
a certain number of tribes, and to the examimation of one or
more organs in all their various modifications or changes of as-
pect ; and the works which treat of a single natural family with
all its species, now generally called monographs, have made us
perhaps better acquainted with plants than the invention of any
artificial system, except the Linnean alone. The accumulation
of facts thus increasing by the daily investigations of philosophers,
each in their own particular subject of research, are for the most
part scattered through philosophical journals or foreign publi-
cations, not always easy to be procured, and often unintelli-
Lindley’s Introduction to Botany. 445
gible to the general reader from the abstruse and complex man-
ner in which they are written. To collect these facts together,
to present them in one unbroken tableau, to arrange them syn-
thetically so as to throw light on the whole system, is the office
of an introduction to botany, and its author is seldom more than
a redacteur of the minute and laborious investigations of others,
as many a tolerable botanist has never read the original works
of Bonnet, Amici, or Dutrechet, and many of the same class
would have never heard of these philesophers or their disco-
veries but for the same easy and convenient medium.
Introductions to botany, therefore, besides their value in
mitiating the learner into all the elementary knowledge requisite
to be possessed before pursuing his own observations, become a
kind of evidence of the progress of the science, a statement of
the increasing quantity of facts which have been discovered in
the different stages of its improvement, and resemble, in some sort,
resting-places on the ascent of a mountain from which the pros-
pect is seen to grow more extensive the higher we proceed. If
we compare the early elementary works containing a few simple,
prima facie characters, perceptible to the commonest observer,
with the Philosophia Botanica, that has laid down the rules and
furnished the matter for so many succeeding works, (in most of
which we perceive a gradual disposition to depart from the sim-
plicity of their model,) and this last with the abstrusely analo-
gical treatises of the modern French school, we shall find that
the fullest elementary works written a few years back will leave
us totally ignorant of some of the most important truths respect-
ing vegetable organization and natural relations, a perfect know-
ledge of which seems the ne plus ultra of botanical philosophy.
It is evident, therefore, from the mass of facts which modersa
discoveries are daily pouring in, that an introduction is abso-
dutely necessary at least every three or four years, and one pub-
lished at any moderate space of time after another can scarcely
fail to contain a considerable quantity of information which was
wanting in the antecedent.
The best works (at least those with which we are most fami-
liar) are Richard’s and De Candolle’s Elements, both published
within a few years, and containing the new philosophical theories
which originated principally among the French. The latter
work we believe was the first that gave a popular exposition of
the cohesion and abortion of vegetable organs by which so many
of the anomalies in natural affinities are explained, and the for-
mer as translated by Dr. Clinton in 1829, was the text book for
Irish students during the following years; but new discoveries,
particularly microscopic observations, have added so much to
the bulk of acquired knowledge, and thrown so much light on
VOLVANO. AO. <1) 5 ae HaSeugls a Al;
446 Bibliographic Notices.
some uncertain, though not unimportant points in physiology, that
2 new elementary work was partly again to be desired, and the
desideratum Professor Lindley has, if not fully, at least sufli-
ciently well supplied. But we must not suppose that his intro-
duction from its additional stock of information should alto-
gether supersede that’ of Richard, which is superior to it at
least in one respect, from its giving a detailed account of a
branch of the subject, which the former work has left altogether
untouched, as we shall show hereafter. |
Professor Lindley has arranged his work in seven books,
of which the first. and longest is occupied with the structure
of vegetable organs in all their modifications, according ‘to
the latest theories of organography afforded by Mirbel, De
Candolle, and others. The most interesting part of this
book is the opening chapter, in which he gives an explana-
tion of the elementary organs of vegetation, commonly called
vegetable tissues, so necessary to be known when “we consider
the importance of anatomical peculiarities in determining the
primary divisions of the vegetable kingdom, and how imper-
fectly it has been hitherto explained or understood. xcept
in determining the nature of cuticular stomata and the ter-
mination of spiral vessels, Professor Lindley has not been
able in this book to give us much original information of
his own, but he can adduce his own evidence to many facts
which bear the authority of others, and it is often not alto-
gether unsatisfactory that a second person can vouch for the
reality of anatomists’ discoveries. ‘This chapter contains a mi-
nute and detailed account of all the facts that late investigations
have proved or attempted to prove respecting cellular and vascu-
lar tissue, and in this particular it is superior to any elementary
work on general botany, which has yet been published. But
the student must be prepared, in commencing this chapter, to
abandon many opinions which he had formerly received as ca-
nons, such as the nature of fibrous tissue, and the existence of
yarious species of vessels distinct from the spiral. His account
of the microscopic structure of woody fibre and spiral vessels
is particularly worthy of attentive perusal. In the next chap-
ter he proceeds to the consideration of compound organs, a tho-
rough knowledge of which is much more necessary to be acquired
‘than of the elementary, as the arrangement of every system is based
more or less on their formi and characters, and as the nature of
tissue, from its minuteness, requires the aid of good glasses and
too. nice a process of examination to be easily studied by
learners. It is very desirable that both the external appear-
ance and anatomical structure of those compound organs should
be correctly and intimately known, as-it is by their various mo-
difications that all the laws of vegetable life are carried on, but
Lindley’s Introduction to Botany. 447
it appears to us that Professor Lindley has spun out to too great
a length his description of every minute portion that enters into
their construction, and perplexes with too many minutiz the
botanical student, who, in an introductory work, seeks rather
for a clear and explanatory statement of whatever facts are
really important, than a profound investigation into all the vari-
ous Opinions respecting their nature, which different writers
have promulgated, and the various names by which, at different
times, they have been designated. It is too much the custom
among botanists, when an uncertainty exists relative to the
function of any particular organ, or to the class or species to
which it is to be referred, to remedy or attempt to. remedy. the
doubt by suggesting a new theory, or publishing a new opinion
of their own, equally uncertain as to accuracy, or rather equally
remote from the truth, a kind of homceopathy by no. means
agreeable to the student, to whom the mass of conflicting doc-
trines among which he has to select a belief, is a remedy. worse
than the evil. It would be desirable that Professor Lindley
had not overloaded his text with such a profusion of synonyms,
they would better have been collocated in a glossary at the end
of the work. Asa specimen of his redundancy on this subject
we shall quote the following passages :
“¢ Stomata.—Pores of the epidermis; pores corticaux, allongés,
evaporatoires, ou grands pores ; glands corticales, miliaires, or epi-
dermoidales; glandulz cutanex. Oceffnungen; Stomatia.”—p. 33. -
“* Netted leaf.—It is the folium venosum of Lin.; the f. indirecté
venosum of Link ; the f. mixtinervium of A. Richard: and the f. reti-
nervium of De Candolle. If the ven extern and venule margi-
nales are conspicuous, Link calls this form combinaté venosum ; but
if they are indistinct he calls it evanescenté venosum.”’—p, 92.
‘The second book treats of physiology in all its branches, and
we wish our limits would permit us to give a long extract from the
first chapter, which is an exceedingly good epitome of the man-
her in which the two chief modifications of vegetable structure,
and consequently vegetable life are developed, and the laws by
which their vital functions are regulated ; but we can only recom-
mend it to the attentive perusal of all who wish to be acquainted
with that very interesting subject. In the following chapters he
proceeds to the examination of the physiology of these organs ta-
Ken separately, after having considered their combined action in
the entire vegetable. The whole book is by far the best arranged
of any in the introduction, and contains the greatest quantity of
valuable information, given in the clearest and most pleasing
manner. In the third book, entitled Taxonomy, he proceeds
to explain the principles of classification, and the two great
448 Bibliographic Notices. —
systems to which these laws are applied. The first chapter of
this book is devoted to the consideration of artificial classifica-
tion, and here we must say a few words, in passing, to deprecate
the spirit of invective with which many disciples of the modern
school of botany allow themselves to speak of the Linnzean sys-
tem, and its ever illustrious author. Between the systems of
Jussieu and Linneus there can be no rivalry, for they can or
ought to exist independently of each other: to the first may be
allowed its profounder philosophical views, its more extensive
knowledge of nature, and the superiority of having grouped the
vegetable kingdom as near as possible to the manner in which
they were primitively arranged by the Creator himself; but
still for ascertaining a new plant we must acknowledge the ab-
solute necessity of the Linnean system, or some other artificial
arrangement, no matter how arbitrary are its rules, or how far
it departs from natural affinity in its grouping so as it presents
a few obvious characters for distinguishing genera and species ;
such a method must exist as long as there are new. plants to be
discovered, or new botanists to find those plants which are
already described. Between the two no comparison can be
fairly drawn ; they differ in their characters and principles as
they do in their use, and when we hear of the imperfection of
the Linnean system, as. relative to the natural method, we
must beg that another system will be invented by which a
new: plant can be ascertained at first sight before it can be
studied in its more important station among the natural families.
The third chapter commences with an explanation of the prin-
ciples of natural classification, which are given in a few words
with more conciseness and perspicuity than we have seen any
where. He says— |
«A natural method of arrangement differs essentially from an ar-
tificial one in this, that it does not depend upon modification of any
one part more than of another. Its divisions are framed from a care-
ful consideration of every, even the minutest, character that is ap-
preciable, and consist of species, not arbitrarily collected by a few
common signs, but agreeing with each other as far as possible in every
material point of structure. Groups formed upon this principle will
necessarily consist of species having a greater resemblance to each
other than to any thing else, and if skilfully constructed, will have
so great a general resemblance, that a knowledge of the structure,
habits, qualities, or other important peculiarities of a single species,
gives an accurate general idea of all the others that the group con-
tains.” —p. 318. . |
-. But'we think Professor Lindley has erred in giving us. the
original form’ in which Jussieu published his system, instead of
Lindley’s Introduction to Botany. 449
the more modern arrangements, which, being the latest, must be
supposed the best. Richard, in his « Elements,” has here
given us a separate account of each of the natural families,
which, together with the illustrating notes of the translator,
makes us in some degree familiar with the whole system. This
omission Is a great want in Lindley’s work, and might be sup-
plied to the exclusion of less useful matter. The fourth book
is occupied with glossology, separated with great judgment
from organography, with which it is too often incorporated.
Every student should make himself pretty well acquainted with
those botanical terms to enable him to discover and describe
plants with facility. The next. book treats of phytography, or
“The Rules to be observed in describing and naming Plants.”
We are of opinion that much superfluous matter might be omit-
ted here, and all the information that is of importance added
to the chapter on the value of characters in the third book.
The geography of plants occupies the sixth division, a subject
of creat interest, and very deserving of being accurately inves-
tigated, All the observations that have as “yet been made on
the subject have furnished us with few certain data, as so many
unknown causes, independent of latitude, or any apparent dif-
ferences in soil or other local circumstances, influence the ap-
pearance and disappearance of plants. Professor Lindley has in
this book given a compendium of all the principal discoveries
which Humboldt and others have made on the geographical
distribution of plants, and every person who has it in his power
should endeavour to add some knowledge to the little we pos-
sess on this very interesting branch of botanical. philosophy.
In the seventh and last book we finally come to the con-
sideration of the theory of morphology, which we shall explain
in his own words :—
“That part of botany which treats of the gradual transmutation of
leaves into the various organs of a plant, which shews that bracteze
are leaves affected by the vicinity of the fructification, that the calyx
and corolla are formed by the adhesion and verticillation of leaves,
that the filament is a form of petiole, and the anther of lamina;
and, finally, that the ovarium itself is a convolute leaf, with its costa
elongated into a style, and the extremity of its vascular system, de-
nuded under the form of stigma, is called morphology.”’—p. 504.
We have heard that.some heathen philosophers defined the
soul as harmony, others as numbers, &c. ; but here we find that
the life, soul, and essence of vegetation consist in a leaf. ‘This
evidently is considered a bonne bouche, and as such reserved
for the last. In the book on organography the subject is deli-
cately hinted at, and brought to agree with the principles of or-
450 Bibliographic Notices. |
ganization, from which it emerges like a phantasma from the
windings of a magician’s wand. The doctrine is certainly true
in many respects, and, according to the prevailing taste for
analogy of every kind, appears extremely philosophical ; but on
a little examination, we shall find that the theory is neither so
verv wonderful, so very correct, or even so paradoxical, as it ap-
pears at a first glance. When we consider the extreme sim-
plicity of the chemical basis of vegetable matter, and the equal-
ly simple nature of the tissue which is formed by the combina-
tion of those elements, we can easily conceive that the organs of
vegetables must partake more or less of the same nature, and
that the character of one organ will merge into that of another,
if influenced by causes which are for the most part hidden from
our perception. - Nature seems to have imposed one inviolable
commandment on vegetation, that of the ascending and descend-
ing caudex of terrestrial plants, a problem which most likely
never will be solved but by considering it as a fiat of the Crea-
tor. The other principles of growth may be considered laws of
discipline, which may be altered by some internal circumstances
of its development with which we are unacquainted ; this being
the case, we should not wonder if the cellular and vascular tis-
sue, which is usually employed for the elaboration of some pe-
culiar nutriment, might, by the addition of much aqueous fiuid,
(Dutrochet would say a superabundant endosmose), lose their
power of forming those refined secretions, and spread into a
less highly organized formation, as stamina into petals, sepals
into leaves, &c. Of regular metamorphosis, such as the con-
stant and uniform change of whorls of leaves into calyx, corol-
la, stamine, and ovaria, of which the seeds are modified buds,
it is perhaps more difficult to prove either its accuracy or its
futility. The only remaining doubt seems to be, whether these
organs actually were the rudiments of leaves in the early period
of their formation. The belief that they were seems now ge-
nerally received as an explanation for all ditficulties, for we hear
that the writings of Linneus and Gertner are “a mere tissue
of ingenious misconceptions” (speaking of the pistillum). De
Candolle, Du Petit Thouars, and Gothe, have proved that it is
nothing but a leaf! ‘The plan upon which all vegetable beings
are created is so uniform, and the rules under which their struc-
ture is modified are so simple and economical, that we might
be tempted to refer this apparent change rather to analogy or
similarity than to identity of organization. The pericarpium
is formed of veins and cellular tissue corresponding to the pa-
renchymatous and vascular lamina of leaves ; the ovula resemble
buds, with this difference, that the latter are not furnished with
Dr. Turnbull on the External Application of Veratria. 451
an ascending and descending caudex. But must it follow from
this that they actually are modifications of leaves? For what
purpose should nature create an organ with the design of sub-
sequently changing it into another? On this subject much may
be stated for and against; nor are we prepared to give our
opinion arbitrarily on it: but certainly the explanation folium
est has not the same talismanic effect on us of clearing away
every difficulty in the nature of vegetable organs, as some have
imagined, nor does the term carpellary leaf suggest a clearer
idea of its structure than a many-celled ovarium ; at all events,
whether their nature is or is not changed, they are at the pe-
riod of their development a distinct organ, and in botanical ter-
minology they should be named as such ; for as we know that
the foot, from similarity of structure, may execute the functions
of the hand, (different from any other organs of the human
jrame, which are formed each for their own purposes, and in-
capable of being used for another), should we for this reason
apply the same name to designate both. It will probably soon
become highly unphilosophical to call the human arm by any
other name than that of superior leg, and the former word will
cease to be used, except by dress-makers and tailors, to distin-
guish the members that are suited with a pair of sleeves from
those which are usually accommodated with a pair of trowsers.
But to speak seriously, the whole of this seventh book is ex-
ceedingly curious, and well worth the trouble of reading. The
theory of morphology is so generally adopted, that every young
botanist should make himself somewhat acquainted with its
principles, and we leave it to his own judgment whether he will
give it implicit credence or not. |
-- We shall now conclude this article with declaring our fa-
vourable opinion of Professor Lindley’s work ; and, though we
expressed our disapprobation of some points, they are far out-
numbered by those with which we were highly gratified.
An Investigation into the Remarkable Medicinal Kffects re-
sulting from the External Application of Veratria. By
ALEXANDER TurnBuLL, M.D. London. pp. 96.
TuE system of rubbing in the hands of St. John Long ap-
peared of so much advantage, (to himself at least,) that a host
of imitators instantly arose, all anxious to try this apparently
wonder-working mode of cure. Every variety of local appli-
452 Bibliographic Notices.
cation, which the utmost ingenuity could devise, was put in ac-
tive requisition. Long forgotten medicines, which had had
their day, were dragged from their obscurity and applied to
this purpose, and several new ones, adapted for it, discovered.
No doubt, in many instances, much good was done ; but still
the most uncandid were forced to admit occasional failures, and
an ointment which should never fail was still a desideratum.
This, happily, Dr. Turnbull has achieved, (if we are to believe
the work before us,) by the discovery of the virtues of the Ve-
ratria, which his cases plainly declare to be infallible. This
substance, he tells us, is the active principle of some of the
family of plants, called colchicacee, and has the various names
of veratrinum, veratrina, veratria, and sabadilline. It has been
obtained from the veratrum sabadilla, veratrum album, and.
colchicum autumnale, and is not, as previously supposed, a
simple body, but consists, according to Mr. Conerbe, of three
distinet principles, veratrine, sabadilline, and mono-hydrate of
sabadilline.
_ “The veratria of commerce is nearly white in colour,. and in the
form of a fine powder ; it is without smell, but when accidentally or
otherwise brought in contact with the mucous membrane of the nose,
it induces violent and even dangerous sneezing ; when applied to the
conjunctiva it produces great irritation, accompanied by an abundant
flow of tears, which does not subside for some hours. _ Its taste is ex-
tremely acrid, but destitute of bitterness; and it acts very strongly
on the mucous membrane of the stomach and intestines: if intro-
duced into the stomach, it proves highly emetic and purgative ; for,
even in old subjects, a quarter of a grain acts powerfully on the bow-
els; and in some experiments, the effects have been so violent as to
show that death would have followed the administration of a few
grains.”
Andral, jun. found, that when this substance was applied di-
rectly to the tissues violent inflammation was excited, and when
thrown in small quantity into the intestine, it acted on the large
intestine; and when in larger quantity, tetanus followed.
‘‘ Veratria has been prescribed both internally and externally.
For internal use, it is given in the form of pill, or in -solution, in
dropsy gout, rheumatism, &c.; and externally, it is applied either in
the form of solution, or what is better, in that of an ointment made
with hog’s lard.’ [Twenty grains of the veratria to an ounce of
lard.] ‘‘ And of this, a piece the size of a large nut may be rubbed
from five to fifteen minutes, night and morning, as nearly as possible
over the seat of the disease, until relief from the urgent symptoms
be experienced ; care being taken that the skin over which the
ointment is rubbed be free from injury, otherwise considerable irrita-
Dr. Turnbull on the External Application of Veratria. 453
tion of the part will ensue; and for reasons already given, the person
who applies it must be careful not to insert even the smallest quantity
under the eyelids.”
Strange to say, its effects as an ointment are almost the reverse
of its internal exhibition, and far from irritating, purging, vomit-
ing, &c., its effects are more like those related in an eastern
fiction, or of Dr. Solomon’s Balm of Gilead.
‘It has been observed to calm irritation, remove pain, and pro-
duce considerable elevation of spirits. The general health and ap-
pearance improve ; the appetite remains unimpaired, or even be-
comes better; the patient experiences not the slightest degree of
nausea,” and the bowels become so costive that purgatives are ne-
cessary.
The following looks so like magic, that for the sake of
those who delight in the marvellous, we cannot resist quot-
ing it: |
‘‘ When the veratria is applied externally in dropsical diseases,
the emetic and cathartic effects which result from its internal em-
ployment in these affections are exchanged for a diuretic operation,
so singular and beneficial as to bring about the removal of the effused
fluid, in a time much shorter than it can be accomplished in by any
other known medicine ; and it has done so in many cases after
every other means had been previously tried without avail; but in
diseases unattended by aqueous effusion, no effect whatever on the
kidneys has been observed.”
The unpleasant irritation which follows friction with tartar-
emetic ointment, croton oil, &c. is not observed.
“« The skin over which the ointment has been rubbed, even after
the friction has been continued for some length of time, shows no
marks of irritation, and although in certain instances a slight blush
sometimes pervades the surface, it nevertheless vanishes in an hour
or two, and the skin returns to its natural colour. When the quan-
tity of veratria rubbed in exceeds a few grains, the patients generally
experience a considerable degree of warmth and tingling in the part ;
and until this takes place the peculiar effects of the medicine do not
usually manifest themselves ; the circumstance, therefore, is one
worthy of attention, and may serve as a criterion whereby to esti-
mate the extent to which the friction may be carried without pro-
ducing inconvenience, and also to judge of the degree of purity of the
veratria employed ; for when, as is sometimes found to be the case,
the medicine is mixed with impurities, these sensations are not pro-
duced, and its action is by no means either so certain or powerful as
when it is free from adulteration. This last observation appears ne-
VOL. v. No. 15. 3N
454 Bibliographic Notices.
cessary to prevent the practitioner from laying a charge of failure
against it in cases where the impure veratria may have been made
use of in compounding the prescription.*
“After the ointment has been applied a sufficient length of
time to put the constitution completely under its influence, the feel-
ing of heat and tingling extends itself from the place where the
friction may have been made, over the whole surface of the body, and
in some instances involuntary twitchings of the muscles of the mouth
and eyelids are induced; bat these symptoms disappear so soon as
the rubbing has been discontinued for a day or two, and no disagree-
able consequences follow to the patient. The sensibility of the parts
over which the application has been made, is increased to such a de-
gree as to render them peculiarly susceptible of the presence of cer-
tain stimuli, particularly electricity or galvanism. These agents
have, in some instances, been applied along with the veratria oint-
ment, but have given rise to sensations so acute as to render their
further employment almost insupportable, and that without the slight-
est perceptible alteration of the surface. It does not appear
altogether necessary that the friction should be made exactly over
the seat of the disease, for two cases have lately come under obser-
vation, in which the individuals who rubbed on the ointment, imbibed
as much by the hand as proved sufficient to cure them of painful af-
fections in distant parts of the body, under which they had been la-
bouring for a considerable length of time before.” —p. 8.
Some trials were made with the ointment on a surface de-
nuded of its cuticle, but the consequent irritation was too great
to render a repetition advisable.
We have given the above rather copious extracts on the na-
ture and mode of application of the veratria, thinking that many
of our readers who have not the book at hand might be anxious
to have as detailed an account as possible on these heads, We
think it but fair to the doctor to quote the following passage,
which with singular modesty (not always the worst policy) he
prefaces his miraculous cures :
‘Tn an inquiring age like the present, it behoves an individual,
in laying before the profession any new plan of treatment, especially
if that be applicable to diseases which have heretofore been considered
either very obstinate or incurable in their nature, not to say more in
its favour than the facts brought to light during its investigation war-
rant; for experience teaches us that many remedies, the prudent use
of which might have rendered the most essential service to medical
science, have suffered, often irremediably, in consequence of the rash
cee TS ee ee
* Pure veratria is entirely soluble in alcohol, and burns without leaving any
residuum.
Dr. Turnbull on the External Application of Veratria. 459
and inconsiderate praises heaped upon them by their discoverers.
On this account it is intended to do nothing more than merely to
state the cases as they have occurred, in the hope that they may not
be thrown aside as savouring too much of the marvellous, but that
they may induce other labourers in the same field,” &c.
Before proceeding to lay before the reader some of his cases
(which we have read with great care), we may repeat the ob-
servation, that he is much too modest in the remarks just quot-
ed. Out of the forty cases given there is not a single failure,
they are all cures! And these not in trifling affections, but
most of them in what have been hitherto considered by the pro-
fession as incurable, and where we are told every thing likely to
effect a cure in the usual way had been resorted to in vain.
Nay, so far does the Doctor’s anxiety to show the superiority
of his own miraculous unguent carry him, that he has in some
cases kept the patients six weeks, two months, and upwards,
under his care, giving them the most powerful drugs our Phar-
macopoeia affords, (till, in one case, such debility ensued as en-
forced their discontinuance ;—in all, the disease remained un-
subdued,) before resorting to the veratria omtment, which had
the alleged effect of almost instantly removing the disease, a re-
sult we see no reason to doubt would as readily have happened
at first, to the infinite advantage of the patient’s constitution and.
pocket, though in this last respect, not so much to the Doctor’s.
Another feature in these cases is, that most of them are as for-
midable from their duration as their nature, of sixteen, twenty-
two, thirty-six years’ continuance; and it is quite delightful to
read of one of these ancient plagues of years’ standing being
removed by one friction of a few minutes. ‘The curative power
of the veratria is shown to be by no means confined to one class
of diseases, but embraces a most satisfactory variety, including
almost all the most common, obstinate, or incurable diseases,
with the exception of consumption, the cure of which has been
monopolized by St. John Long, Doctors Scudamore and
Ramadge.
This uniform success in such very different diseases by the same
remedy of course renders a very accurate diagnosis of compara-
tively small value ; it matters little to you whether your patient
labours under incurable “ disease of the heart,” “tic doulou-
reux,” or any of the thousand Protean forms of “ neuralgia,”
“rheumatism, acute and chronic,” “palsy,” “ apoplexy,”
“ ascites,” “ anasarca,” ovarian dropsy,” “‘ amaurosis,”
“ pains in the great cavities,” “syphilitic nodes and pains,”
(several examples of the cure of each of which are presented to
us,) all you have to do is to ascertain that he is diseased, or
456 Bibliographic Notices.
thinks he is, and if so, to apply friction with the veratria oint-
ment, which these forty cases, all cures, show, is equally to be
resorted to in organic as functional diseases. Neither need
you trouble yourself with age, sex, or constitution, as they tell
us that the “sanguine,” “robust,” “ stout-made,” and “rud-
dy complexion,” were treated precisely the same, and quite as
successfully, as the “delicate,” the “hysteric,” those “of a
weak constitution,” and “ spare habit of body ;” and the cures
include all ages, from the ‘“ delicate boy of twelve,” to the
« old gentleman about seventy.”
There is one thing in the composition of Dr. ‘Turn-
bull’s cases which we particularly regret, as affording am-
ple food for the suspicious mind, we allude to the total
omission (with the exception of two unsatisfactory exceptions
at pp. 77 and 84) of names, dates, and places, the two
last are never mentioned, and in lieu of the first we are plen-
tifully supplied with letters of the alphabet, from Mr. B. down
to Mrs. W. ‘There is also a very remarkable similarity in the
frequent recurrence of some peculiar and not very common
symptoms, “ pain down the left arm,” “loss of memory,” &c.
The first class of diseases cured by the veratria oimtment are,
heart complaints, either organic or functional ; we say organic,
for though Dr. Turnbull merely holds out the hope of alle-
viation, and professes to repudiate the idea of cure in such
cases, yet as he gives one or two instances, we do not see why
we should reject this desirable effect of the veratria, so mani-
festly displayed :
‘‘The ointment best adapted for use in affections of this class
consists of fifteen or twenty grains of veratria carefully mixed up
with an ounce of lard, and of this a piece the size of a nut is rubbed
over the region of the heart for five minutes, once a day. In all the
cases which have come under observation, a few such applications
have generally proved all that was requisite either to effect a complete
cure, or at least, to cause a cessation of the symptoms for a conside-
rable time ; the friction may then be employed at longer intervals,
and should any slight accession take place it may be removed by a
repetition of the same means.”
This is very satisfactory news to the invalid.
‘Tt has happened that from one application the symptoms, and
particularly the palpitation, have been increased to such a degree as
to render it impossible to induce the patient to submit to a second.”
After this has subsided,
‘<In a day or two every trace of disease has disappeared. The
urine is observed to be copious.’’
Dr. Turnbull on the External Application of Veratria. 457
The first case is that of a lady who was almost entirely con-
fined to an apartment of an equable temperature for seven years;
with cough, dyspnoea, purplish lips, palpitation, &c. along with
a numbness and loss: of the use of the left arm. She had ‘ been
under almost every variety of treatment without benefit,’ and who
the Doctor (for a reason, having so speedy a cure in his hands,
we may be permitted to guess) tried with purgatives, tartar
emetic, creton oil, friction, &c., for a considerable time with
some relief, but such debility occurred, that he looked on the
case as hopeless even to veratria: in this, however, he was quite
wrong, as
‘In about a fortnight from the first application of the veratria,
she was able to leave her room, and walk up and down stairs with
facility.”
And shortly after, every bad symptom having disappeared, the
lady, who had never left her room for seven years, walked four
miles to see her Doctor. He acknowledges this to have been,
under ordinary treatment, a hopeless case of organic disease.
Case V.—‘“ Mr. W., aged 58, has been affected for seventeen
years with palpitation, which, during the last seven of that period,
has been attended by great difficulty of breathing, occurring in pa-
roxysms, coming on especially whilst taking exercise on foot. The
dyspnoea at these times has been so severe, and has been accompanied
by such severe pain across the chest, as to compel him to lay hold on
the nearest object for support. .The pain, during the fit, extends down
the left arm, and is of such intensity, that, in the words of the patient,
no language can describe it.
‘‘ For these and other symptoms he has, during the last ten years,
applied to all sources for relief, and almost every possible remedy has
been tried, without procuring for him any ease. At the time he came
under treatment, he had, besides the symptoms mentioned, a peculiar
purple blush upon his face, and more particularly over his nose and
lips; his voice was weak and quivering. Upon applying the ear over
the region of the heart, a tremulous, confused, irregular pulsation
was heard: the pulse was irregular, and very intermittent: the left
side of the chest appeared much larger than the right, and the ribs
over the cardiac region seemed pushed out, as if to afford a larger
space for the heart's action. There was considerable distention cf the
abdomen, along with a very evident degree of enlargement on the
right side, immediately under the margins of the ribs; his bowels
had been for some time in a very torpid state, and required rather
strong medicine to operate upon them; the lower extremities were a
little swollen, and the urine deficient in quantity. His sleep was un-
refreshing, and often disturbed by fits of coughing, which generally
ended in great exhaustion.”
458 Bibliographic Notices.
An ointment of the usual proportions was ordered to be
rubbed, for five minutes night and morning over the region of
the heart ; and, in the course of three days, the feeling of pain
and constriction across the chest had entirely disappeared. As
the pain in the left arm still remained, he was ordered to use
frictions with the ointment to it also, and almost immediate
relief from that symptom followed the application. In six weeks
he could walk about, and up and down stairs without inconve-
nience; and rubbing the ointment when any symptom reap-
pears, he is enabled to pursue his avocations with ease and
comfort.
The cases we have just quoted are cheering enough, but not
a bit more so than those which immediately follow of neuralgia,
which do not appear less amenable to this pain-dispersing spe-
cific. Let us hear Dr. Turnbull.
<< In no class of diseases have the beneficial effects of the veratria
ointment been more strikingly manifested than in that which it is
now proposed to bring under consideration ; for in none are the symp-
toms productive of more distress to the patients, and by no other
means can the same degree of relief be afforded in so short a period.”
Scarcely an exception, we are informed, (and none is given,)
to a cure occurs, after, as usual, having resisted every treatment
for years. In tic-douloureux especially the anguish of years is
dispersed in a few minutes by one friction. If the disease is not
confined to one particular spot, but spread over the ramifica-
tions of the nerve, he considers it easier to subdue, and a smaller
quantity of the ointment necessary. Where the disease is seated
in a single spot, particularly in the frontal nerve, a continuance
of the frictions are necessary. In the first mentioned cases twenty
grains to the ounce must be rubbed over the whole seat of the
pain for fifteen or twenty minutes, “ or what is better, till the
heat and tingling caused by the friction have been so great as
to produce” an effect equal to that of the disease itself, and then
the friction may be discontinued for a short time, to see if the
pain is less than before; sometimes one friction suffices, if not, it
must be continued. Where the pain is circumscribed, to pro-
duce a full effect, forty grains to the ounce have been used. A
caution is given to avoid letting any get in contact with the con-
junctiva.
We shall give a case of cure, premising that we cannot help
reprobating in the strongest manner Dr. Turnbull’s conduct in
this case, and wonder how, having a powerful remedy, if not a
certain cure (as he sets forth) in his hands, he could have the
Dr. Turnbull on the External Application of Veratria. 459
heart to keep his unfortunate patient under the use of medicines,
exercising the most powerful effects on the constitution, for two
whole months, till, to use his own words, “her health was now
much weaker, but her sufferings continued unabated,” and never
once apply that remedy.
‘A lady, 55 years of age, of a spare habit of body, has been
affected for the last 36 years with tic-douloureux in the cheek, and
in the forehead above the eyebrow, on the left side. From the com-
mencement of the disease, she has had a paroxysm generally once a
week, and at no time does she remember the interval to have been
greater than fourteen days. Her sufferings during this attack have
been extreme, and have compelled her to confine herself to bed until
its termination ; and it has never lasted a shorter time than two days.
In the intervals, however, she has been perfectly free from pain, and
her general health has all along been tolerably good. It appeared
from the history of the case given by the patient, that throughout
the long course of the disease, almost every kind of medical treatment
had been put in practice without giving rise to any permanently good
result, and in consequence of this circumstance, and as the symptoms
appeared to admit of nothing but slight alleviation, if even that could
be procured, she was ordered to keep the bowels open by the use of
an aperient pill, and at the commencement of every paroxysm to take
a small dose of acetate of morphia, and to repeat it every hour until
the pain abated. She persevered in these means for two months,
and experienced considerable relief; but, although the violence of the
symptoms was moderated, neither any diminution of the length of
the attack, nor any change in the duration of the interval, could be
observed.
“ Seeing that such was the case, and that the general health of
the patient was beginning to suffer from the morphia, it was order-
ed to be discontinued; and she was directed to take small doses of
strychnia, for the purpose of removing, if possible, a paralytic affec-
tion of the upper eyelid, and of the left side of the face, which had
come on during the previous existence of the disease. This course
was persevered in, until the convulsive twitchings, brought on by the
medicine, became as strong as the patient could bear them, but
without producing any effect on the paralysis.”
She was ordered to rub veratria ointment, (gr. xx. ad Zi.
axungiz,) and in about fifteen minutes all uneasy sensations
were removed. In two hours they reappeared, but were re-
moved in a few minutes by the same treatment. A return in
ten days was dismissed by the same means ;
“¢ And from this time the patient had only one or two very slight
accessions, but these were at once cut short by the use of the oint-
ment for a few minutes. It is four months since the last attack came
460 Bibliographic Notices.
on, and she is at present quite free from the disease. The paralysis
of the eyelid also went away.”
Several cures of severe neural gic pains in the back are given,
and many slight ones hinted at. The possibility also of curing
them in every other part of the body is undoubtingly affirmed, a
most modest invitation of the doctor’s, which all so affected will
of course lose no time in accepting, and thus procure at his
hands instantaneous relief. Cures of acute and chronic rheu-
matism next follow, after which a very frequent and hitherto
fomidable class of diseases are given,—those of ‘paralysis.’
We are told—
‘‘ In two or three cases the patients had almost entirely lost the
power of motion in one side of the body, but recovered it again, by
making use of frictions with the ointment over the affected extremi-
ties, and more particularly along the course of the nerves.”
Among other wonders is the hopeless case of a gentleman
seventy years old, who had palsy combined with rheumatism,
and was unable to move the affected limb. The never-failing
yeratria ointment soon put motion into this ‘ancient of days,’
and two hours after the friction he could walk about the room.
We are next presented with an equally interesting group of
cases of dropsy, viz., hydrothorax, ascites, anasarca, and dropsy
of the ovaries, almost all wonderful cures, not the least among
which are two cases of that before indomitable disease, ovarian
dropsy.
In dropsy we are cautioned to diminish the strength of the
ointment in proportion to the extent of surface over which it is
to be rubbed.
‘The quantity of urine evacuated by the patient, in some in-
stances, almost exceeds belief.”
One instance where sixty-four pints were evacuated in four days,
we presume is of this number. In conclusion, Dr. Turnbull tells
us how successful the veratria ointment has been in Ais hands
in gout, amaurosis, syphilitic pains, &c. In amaurosis, a pa-
tient who could only distinguish light from darkness, the eye-
sight was restored, by one friction, so as to be able to read a
small printed book with ease.
Such are the boasted virtues of the veratria as set forth in
this production of Dr. Turnbull’s. That it will get a fair trial Gn
spite of the obviously little reliance to be placed on these cases)
by a liberal and enlightened profession, we have no doubt, nor
have we less that it will miserably fail; nay, we have already
Dr. Turnbull on the Eaternal Application of Veratria. 461
personal knowledge of cases of tic-douloureux, rheumatism,
and dropsy, where it has done so. But that the end for which
the book we have just reviewed was plainly written, will be
fully attained, we do not doubt, for an instant, and that the
hypochondriac, the nervous, the credulous, the despairing, will
crowd to fill Dr. Turnbull’s pockets.
J. H.
VOL. Vv. NO. 15. 30
SCIENTIFIC INTELLIGENCE.
CHEMICAL AND PHYSICAL SCIENCE.
On a Method of so far Increasing the Divergency of the two Rays
in Calcareous Spar, that only one Image may be seen at a time.*
_-Under this title, Mr. Nicol some years ago described in the Edin-
burgh Philosophical Journal, (No. XI. p. 83,) an instrument which,
at first sight, does not seem to possess any superiority over a good
achromatised prism of calcareous spar, but which, however, I am
convinced from my own experience, does possess important advan-
tages, inasmuch as it throws the images farther asunder than any
one I have met with; and I do not even except the parallelopiped,
prepared according to Wollaston’s directions from two prisms of cal-
careous spar in which the chief sections are made to cross at right
angles.t Nicol’s instrument not ohly answers in place of tourmaline,
the green variety of which, as is well known, is difficult to be obtain-
ed; but it actually surpasses it essentially, in a property so important
in many investigations, that of exhibiting the colour phenomena of
crystals and other bodies in polarised light in a manner perfectly
pure, and free from foreign tints of colour.
The construction of this instrument will be most easily understood,
by reference to the accompanying figure, which represents the in-
strument as sent from England, and for the use of which I have to
thank the politeness of Professor Dove. A section of it is here given
of the natural size. ab, a’b’, is the principal section of a
rhomboid of calcareous spar, which has received the
dimensions here represented by cleavage. The long
edges, a b! and b a’ are the natural obtuse edges of the
rhomboid: while the terminal planes a 6 and a’b’, are so
cut as to form an angle of 68° at a and a’; whereas, in | 46 9}
their natural state, the angle is 71°. The rhomboid thus La i a
modified, is cut through in the direction of the line 6 6’, —
perpendicular to the principal section and to the terminal planes a 6
and a/b’; and after both the new surfaces have been polished, they
are again united by Canada balsam. Both the prismatic halves of
a a ee rrr ee
* From Poggendorf’s Annalen der Physik und Chemie, vol. xxxix. p. 182.
; A similar construction for quartz, described and figured in Herschel’s
Treatise on Light.
Scientific Intelligence. 463
the rhomboid* can also, as is more easily effected, be cut in the
necessary form from two different pieces, taken either from one or
from two crystals. The whole is inserted in the cork PPPP, which
has been cut through and again united.
If we look at an object through this rhomboid placed longitudi-
nally, parallel to the edges ab’ and ba’, we see only one image in
this direction, and that the ordinary one; the extraordinary image
comes first into view when we incline very much the long axis of the
instrument in relation to the line of sight, and when the power of
seeing directly through is not at all disturbed.. In this manner the
field of sight possesses dimensions which are sufficiently great for op-
tical experiments.
Mr. Nicol has not expressed any opinion as to the cause of this
great divergence. It is clear, however, that the chief cause is to be
sought in the action of the Canada balsam, which, owing to its re-
tractive power (1,549), and which is that between the ordinary
(1,6342), and the extraordinary (1,4833), refraction of calcareous
spar, will change the direction of both the rays in an opposite man-
ner before they enter the posterior prismatic half of the combination.
Without this action of the Canada balsam, the cutting through and
uniting the rhomboid would be of no use, as was at first evident to
us, but which has been confirmed by experiment.t Whoever will
take the trouble, may calculate accurately the course of both rays,
and even of each colour, by means of the already existing data and
formule.
Upon the plan just described, the mechanician Hirschmann has
prepared several of Nicol’s rhomboids, which are in all respects the
same with that sent from England. Two of them which I myself
possess, are as perfect as I could wish them to be. In looking through
one of them at a fine line drawn on paper, the line appears quite
simple.t If we use both, and place them behind one another, direct-
ing them upon an object in a horizontal direction, we find, that, when
the principal sections are parallel, the object is seen with nearly as
much brightness and absence of colour, and with nearly half the dis-
tinctness, as when it is regarded with the naked eye; if, however,
* Accurately speaking, the combination is not a rhomboid, but an oblique
rhombic prism, since the planes make unequal angles at the three edges of the
obtuse solid angles.
+ Mr. Nicol was aware, that the increased separation of the images depended
on the Canada balsam with which the halves of the rhombic prism was united.
If the two parts be united by water, the light sustains total reflection.—
kdit.
-¢ On the other hand, the extraordinary image. which is obtained by the
strong inclination of the rhomboid receives a mixture of the ordinary one, and
the field appears on that account brighter. This is of no disadvantage in the use
of the instrument. We also observe a series of feebly coloured edges on the
boundary of the two fields of sight, and this is also the case in the rhomboids
made in England,
464 Scientific Intelligence.
we turn one round until the principal sections are made perpendicular
to each other, we then have, at least in the middle of the field, per-
fect darkness. The weak light which is still visible,* is evidently
derived from reflection on the lateral planes, and would undoubtedly
be removed if we blackened them. If, while the principal sections
cross one another, we insert between the two rhomboids a plate of
calcareous spar which has been cut perpendicular to the axis, we ob-
tain a combination entirely formed of calcareous spar, which exhibits
the phenomena of coloured rings with the black cross as distinctly as
they are obtained by any other method. If we now interpose a plate
of mica, of the proper thinness, before and behind the plate of calca-
reous spar, between it and the rhomboid, so that the axes of these
two little plates may cross each other at right angles, and at the same
time bisect the right angle between the two principal sections, we then
see the coloured rings without the cross having the black centre, and
quite similar to the Newtonian rings. An interesting modification
of these phenomena has been described by Mr. Airy, and was, at an
early period, exhibited to me by Professor Norrenberg.
It may be remarked, that Brewster had previously employed an
analogous method to destroy one of the images in double refracting
crystals.t For this purpose, he cuts a prism from a crystal of
this nature, (as, for example, calcareous spar, arragonite, salt-
petre, carbonate of potash, &c.) and in such a manner, that its
angles may be parallel to the optical axis —he leaves two of the planes
of the prism rough, and fixes glass plates upon it by means of a suit-
able substance. If the substance has the same power of refraction as
the ordinary ray of the crystalline prism, this ray goes through,
since, in relation to it, the planes of the prism are equally polished ;
but the extraordinary ray becomes scattered on all sides as on a rough
plane, and is thus in some measure interrupted. If the substance
has the same refractive power as the extraordinary image, the reverse
takes place. For example, if we fix the glass plates on a prism of
saltpetre, by means of copal balsam, or what is still better, cassia oil,
the ordinary ray, whose refraction is 1,511, passes through unweak-
ened, while the other disappears, or appears only as a red light. ~ If,
on the other hand, we take for the uniting substance, alcohol, or
white of eggs, the extraordinary ray, where refraction is 1,328,
passes through, and the ordinary ray is lost. This plan is decidedly
inferior to that of Mr. Nicol, as the image it affords are dull and
coloured.—Edinburgh New Philosophical Journal, April, 1834.
Professor Faraday’s Recent Discoveries.——In the course of his
experimental investigation of a general and important law of electro-
chemical action, which required the accurate measurement of the
* By making the lateral planes rough, which may be done with a file, there
is scarcely any lateral reflection.— Edit. .
+ Phil. Trans, for 1819, p. 146, and Edin. Encyclop. art. Optics, p. 600.
Scientific Intelligence. 465
gases evolved during the decomposition of water and other sub.
stances, the author was led to the detection of a curious effect, which
had never been previously noticed, and of which the knowledge, had
he before possessed it, would have prevented many of the errors and
inconsistencies occurring in the conclusions he at first deduced from
his earlier experiments. The phenomenon observed was the gradual
recombination of the elements. which had been previously separated
from each other. by voltaic action. This happened when, after water
had been decomposed by voltaic electricity, the mixed gases result-
ing from such decomposition were left in contact with the platina
wires or plates, which had acted as poles; for under these circum-
stances they gradually diminished in volume, water was reproduced,
and at last the whole of the gases disappeared. On inquiring into
the cause of this reunion of the elements of water, the author found
that it was occasioned principally by the action of the piece of platina,
which had served for the positive pole; and also that the same piece
of platina would produce a similar effect on a mixture of oxygen and
hydrogen gases obtained by other and more ordinary kinds of chemi-
cal action. By closer examination, it was ascertained that the platina,
which had been the negative pole, could produce the same effect.
Finally, it was found that the only condition requisite for rendering
the pieces of platina effective in this recombination of oxygen and
hydrogen, is their being perfectly clean, and that ordinary mecha-
nical processes of cleaning are quite sufficient for bringing them into
that condition, without the use of the battery. Plates of platina,
cleaned by means of a cork, with a little emery and water, or dilute
sulphuric acid, were rendered very active; but they acquired the
greatest power when first heated in a strong solution of caustic alkali,
then dipped in water to wash off the alkali, next dipped in hot strong
oil of vitriol, and finally left for ten or fifteen minutes in distilled
water. Plates thus prepared, placed in tubes containing mixtures of
oxygen and hydrogen gases, determined the gradual combination of
their elements: the effect was at first slow, but became by degrees
more rapid ; and heat was evolved to such a degree, indeed, as fre-
quently to give rise to ignition and explosion.
The author regards this phenomenon as of the same kind as that
discovered by Davy in the glowing platina; that observed by Dobe-
reiner in spongy platina, acting on a jet of hydrogen gas in atmo-
spheric air; and those so well experimented on by MM. Dulong and
Thenard. In discussing the theory of these remarkable effects, the
author advances some new views of the conditions of elasticity at the
exterior of a mass of gaseous matter confined by solid surfaces. The
elasticity of gases he considers as being dependent on the mutual ac-
tion of the particles, especially of those which are contiguous to each
other ; but this reciprocity of condition is wanting on the sides of the
exterior particles which are next to the solid substance. Then, rea-
soning on the principle established by Dalton, that the particles of
different gases are indifferent to one another, so that those of one gas
466 Scientific Intelligence.
may come within almost any distance of those of another gas, what-
ever may be the respective degrees of tension in each gas among the
particles of its own kind, he concludes that the particles of a gas, or
of a mixture of gases, which are next to the platina, or other solid body
not of their own chemical nature, touch that surface by a contact as
close as that by which the particles of a solid or liquid body touch
each other. This proximity, together with the absence of any mutual
relation of the gaseous particles to particles of their own kind, combin-
ed also with the direct attractive force exerted by the platina, or other
solid body, on the particles of the gases, is sufficient, in the opinion
of the author, to supply what is wanting in order the render effective
the affinity between the particles of oxygen and hydrogen; being, in
fact, equivalent to an increase of temperature, to solution, or to any
of the other circumstances which are known to be capable of adding
to the force of the affinities inherent in the substances themselves.
Some very curious cases of interference with this action of platina
and other metals are next described. Thus, small quantities of car-
bonic oxide, or olefiant gas, mixed with the oxygen and hydrogen
gases, totally prevent the effect in question ; while very large quan-
tities of carbonic acid, or nitrous oxide gas, do not prevent it: and
it is remarkable, that the former of these gases do not affect the me-
tallic plates permanently; for if the plates be removed from those
mixtures, and put into pure oxygen and hydrogen gases, the combi-
nation of these elements takes place.
The author concludes by some general notice of numerous cases
of physical action, which show the influence of certain modifications
of the conditions of elasticity at the external surface of gaseous
bodies.
The seventh series, which is a continuation of the subject of the
fifth, namely, electro-chemical decomposition,” commences with a
preliminary exposition of the reasons which have induced the author
to introduce into this department of science several new terms,
which appear to be required in order to avoid errors and inaccuracies
in the statement both of facts and theories. As a substitute for the
term pole, and with a view to express also a part of the voltaic appara-
tus to which that name has never been applied, although it be identical
with a pole in its relation to the current, the author proposes to em-
ploy the term electrode. The surfaces of the decomposing body, at
which the positive current of electricity enters and passes out, are
denominated respectively the ezsode and the exode. Bodies which
are decomposable by the electric current are called electrolytes, and
when eleetro-chemically decomposed, they are said to be electro-
lyzed ; the substances themselves, which are evolved in such cases,
being called zetodes, and the terms zetezsode and zetexode being ap-
plied, accordingly as the substance passes in one direction or the other.
* An abstract of Mr. Faraday’s Fifth Series of Experimental Researches in
Electricity will be found in Lond. and Edinb. Phil. Mag. vol. iii. p. 460.
Scientific Intelligence. 467
The propriety and the advantage of employing these new terms, the
author observes, can be properly appreciated only by an experience of
their uses and applications in the exposition of the theory of decom-
position given in the fifth series of these inquiries, and of that of de-
finite electro-chemical action advanced and supported in the present
paper. /
The first section of this paper is occupied with the consideration of
some general conditions of electro-chemical decomposition. It has
been remarked, that elements which are strongly opposed to each
other in their chemical affinities are those most readily separated by
the voltaic pile ; and the discovery of the law of conduction, explained
in the fourth series *, has led to a great augmentation of the number
of instances which are in conformity with this general observation :
but it is here shown, that the proportion in which the elements of a
body combine has great influence on the electro-chemicai character
of the resulting substance ; and that numerous instances occur where,
although one particular compound of two substances is decomposable,
another is not. It appears, that whenever binary compounds of simple
bodies are thus related to one another, it is the proto-compounds, or
those containing single proportions, which are decomposable, and that
the per-compounds are not so.
‘The second section contains an account of a new instrument devised
by the author, for exactly measuring electric currents, and which he
terms the volia-electrometer. The current to be measured is made
to pass through water acidulated by sulphuric acid, and the gases
evolved. by its decomposition are collected and measured, thereby
giving at once an expression of the quantity of electricity which has
passed. ‘The principle on which this conclusion is founded is the
new law discovered by the author, ‘‘ that the decomposing action of
any current of electricity is constant for a constant quantity of elec-
tricity.” The accuracy of this law was put to the test in every pos-
sible way, with regard to the decomposition of water, by making the
Same current pass in succession through two or more portions of wa-
ter, under very different circumstances: but whatever were the varia-
tions made, whether by altering the size of the poles or electrodes, by
increasing or lessening the intensity of the current or the strength of
the solution, by varying its temperature or the mutual distance between
the poles, or by introducing any other change in the circumstances
of the experiment, still the effect was found to be the same; anda
given quantity of electricity, whether passed in one or in many por-
tions, invariably decomposed the same quantity of water. No doubt,
therefore, remains as to the truth of the principle on which the volta-
electrometer acts: but with regard to the practical application of the
principle, several forms of the instrument are described by the author,
and the mode of employing them, either as the measures. of absolute
quantities, or as standards of comparison, are fully pointed out.
* See Lond. and Edinb. Phil. Mag. vol. ni. pp. 449, 450,
468 Scientific Intelligence.
In the third section of the paper, the primary or secondary cha-
yacter of the bodies evolved at the electrodes is discussed. It is shown
that they are secondary in a far greater number of cases than has
usually been imagined ; and that laws have been deduced with regard
to the ultimate places of substances, from the appearance of the se-
condary products; so that certain conclusions, true in themselves,
have hitherto been obtained by erroneous reasoning, since the facts
which were supposed to support them have, in truth, no direct relation
with those conclusions. The methods of distinguishing primary and
secondary results from each other are explained, and the importance
of this distinction towards the establishment of the law of definite
electro-chemical action is insisted upon by the author.
The fourth section is entitled, “On the definite Nature and Ex-
tent of Electro-chemical Decomposition,” and is considered by the au-
thor as by far the most important of this or indeed of the whole series
of investigations of which he has now presented the results to the Royal
Society. He adverts to the previous occasions on which he has al-
ready announced, more or less distinctly, this law of chemical action ;
and also to the instrument just explained as one of the examples of the
principle about to be developed. He next refers to experiments de-
scribed in another part, in which primary and secondary results are dis-
tinguished as establishing the same principle with regard to muriatic
acid; the results showing, that not only is the quantity of that acid
decomposed constant, for a constant quantity of electricity, but that,
when it is compared with water, by making one current of electricity
pass through both substances, the quantities of each that are decom-
posed are very exactly the respective chemical equivalents of those
bodies. The same current, for example, which can decompose nine
parts by weight of water, can decompose thirty-seven parts by weight
of muriatic acid, these numbers being respectively the chemical equi-
valents of those substances, as deduced from the phenomena of ordi-
nary chemical action.
Cases of decomposition are then produced, in which bodies ren-
‘dered fluid by heat, as oxides, chlorides, iodides, &c., are decomposed
by the electric current, but still in conformity with the law of con-
stancy of chemical action, Thus the current which could decompose
an equivalent of water, could also decompose equivalents of muriatic
acid, of proto-chloride of tin, of iodide of lead, of oxide of lead, and
of many other bodies, notwithstanding the greatest differences in their
temperature, in the size of the poles, and in other circumstances ; and
even changes in the chemical nature of the poles or electrodes, and
in their affinities for the evolved bodies, occasioned no change in the
quantity of the body decomposed.
The author proceeds in the last place, to consider a very important
question with relation to chemical affinity, and the whole theory of
electro-chemical action, namely, the absolute quantity of electricity
associated with the particles or atoms of matter. This quantity he
considers as precisely the same with that which is required to sepa-
Scientific Intelligence. 469
rate them from their combination with other particles when subjected
to. electrolytic action, and he brings many experiments to bear upon
this point ; describing one, in particular, in which the chemical action
of 32 5 parts of zinc, arranged as a voltaic battery, was able to evolve
a current of electricity capable of decomposing and transferring the
elements of 9 grains of water, being the full equivalent of that num-
ber. The relation of electricity, thus evolved, to that of the common
electric machine is pointed out in a general way, and the enormous
superiority as to quantity, in the former mode of action, is insisted
upon. In conclusion, the author refers to a statement which he has
made in the third series of these researches,* in which he expresses
his belief that the magnetic action of a given quantity of electricity
is also definite; and he is now more confident than ever that this view
will be fully confirmed by future experiment,— Lond. and Edin.
Phil. Mag., Apri, 1834> |
On the Action of Gases Hurtful to Vegetation.—M. Macaire,
in making some experiments, an account of which he gave to M. De
Candolle, mentioned an accident which had delayed them, viz. the
death of several plants by the exhalation of chlorine. M. De Can-
dolle recommended that it should be tried whether this hurtful action
occurred during the day or night, observing that chemists who had
been consulted on the subject of the exhalations from manufactories,
had almost always insisted, that according to their experiments the
gas had no action on vegetables. M. De Candolle suspected that
these experiments were probably made in the day, a time in which
plants do not absorb gases, which would account for the different re~
sults obtained. The following experiments were made at his sug-
gestion. ;
Chlorine.—Plants of euphorbium, mercury, groundsel, cabbage,
and sowthistle, which had well taken root, were placed in the morn-
ing in a large vessel, in which chloride of lime had been introduced.
The roots were steeped outside the vessel: the quantity of chlorine
disengaged was far from being sufficient to alter the vegetable tis-
sue. In the evening the plants had not suffered, and the odour of
chlorine remained the same.
The same plants, after having passed the night in the same vessel,
to which no chlorine was added, were found quite withered in the
morning, except the cabbage, which had resisted. )
‘The smell of chlorine had entirely disappeared, and was replaced
by that of a disagreeable acid. .
This was repeated several times, making the disengagement of
chlorine stronger, and the result was the same; and the plants in
the day-time withstood a strong atmosphere of chlorine, while a much
weaker dose killed them at night.
Nitric actd.—The experiment, began at night, with the vapour
a
* See London and Edinburgh Phil. Mag. vol. iii. p. 358, et seq.
VoL. Vv. No. 15. 3 P
470 Scientific Intelligence.
of nitric acid, showed that the plants were withered in the morning,
and some leaves were rendered brown by the action of the acid. The
same quantity of acid was tried in the day-time, and though several
leaves were made brown, the others were not withered.
Nitrous acid gas.—This gas appears to be violently poisonous to
plants, and at night it kills them in very small quantity; but in the
day-time they do not appear to be sensibly altered, although the dis-
engagement of gas is abundant.
Sulphuretted hydrogen.—The results of the experiments with
this gas were precisely similar to those of the last. The plants left
during the night in the same mixture of gases which did not at all
injure them in the light, were quite withered in the morning, and
the gas was absorbed. Cabbage only resisted.
Muriatic acid gas.—The results were similar to the last. The
plants did not perish in the day-time, even when there was gas
enough to render one or or two leaves brown; they were completely
dead in the morning, leaving the peculiar smell already mentioned.
Cabbage was still an exception.
It appears, then, from these experiments, that several gases are
hurtful to vegetation, but that their action occurs only during the
absence of light, as M. De Candolle had foreseen.—Jbzd.
Experiments with Potassium and Sodium.—Dr. Ducatel, Pro-
fessor of Chemistry in the University of Maryland, after referring to
Serullas’s experiments on the same subject, (see Phil. Mag. and
Annals, N.S. vol. vi. p. 149,) repeated them with the following re-
sults :
1. A mucilage made with one drachm of powdered gum arabic,
and half an ounce of water, will inflame sodium, most probably for
the reasons assigned by Serullas, as stated above.
2. On wood, sodium most generally inflames in contact with a
drop of cold water; the action being at the same time so violent as
to cause the globule of metal to roll along the dry surface of the
table with considerable rapidity, leaving a white streak of caustic
soda over its path. This experiment, however, does not always
succeed.
3. On a pane of glass, sodium will not inflame when the glass is
clean-and smooth ; but any particles of dust adhering to it will cause
the firing of the metal with scintillations.
4. Ona metallic surface the sodium could in no instance be made
to inflame.
5. On charcoal, which is not mentioned by Serullas, sodium
never fails to inflame, with brilliant scintillations. This is the mode
which I adopt with most confidence, for firing sodium in contact with
cold water. It confirms the truth of the reason given by Serullas,
why sodium will not inflame under the same circumstances as po-
tassium ; namely, the superior temperature which the latter acquires
during its combination with the oxygen of the water: hence the ne-
cessity of placing the former on a bad conductor, in order to avoid
Scientific Intelligece. 471.
the too rapid abstraction of caloric, which prevents a sufficient
elevation of temperature for manifesting the phenothenon of com-
bustion.
6. It is commonly stated, that in the decomposition of water by
sodium, pure hydrogen is evolved. This is a mistake. A portion of
the metal, as in the case of potassium, combines with the hydro-
gen, as may be shown by the following experiment: Take a globule
of sodium, wrap it up in a small piece of paper, and introduce it un-
der a small receiver provided with a stop-cock and jet, filled with
water, and standing over the pneumatic trough. The decomposition
of the water will be effected as usual, and sodiuretted hydrogen
will be collected, which (on opening the jet attached to the receiver,)
being inflamed, burns with a characteristic bright yellow flame. Po-
tassturetted hydrogen, obtained under the same circumstances,
burns with a rose-coloured flame fringed with blue. The potassium,
in several repetitions of this experiment, always emitted light; the
sodium did not.
7. A globule of potassium, placed on a bath of mercury, gradually
amalgamates with the latter, without any rotary motion, if the at-
mosphere be dry; but when breathed upon, it immediately acquires,
as observed by Serullas, a very rapid revolving motion, which con-
tinues for a long time. The surface of the mercury becomes tarnish-
ed, apparently by the accumulation of minute particles of the amal-
gam formed, which at intervals are seen to emerge from beneath the
surface of the mercury, and at some distance from the large globule.
The surface of the liquid metal, within a circle of half an inch to an
inch in diameter, retains its brilliancy. The minute. particles of
amaleam, which I suppose to be the cause of the tarnish, seem to be
repelled by the large globule of potassium, and occasionally, as new
accessions are made to them, they become singularly agitated, ex-
hibiting somewhat of the appearance observed when a drop of vinegar,
or of an acid, comes in contact with a drop of water.
8. Small pieces of sodium, projected upon a bath of mercury, were
not found to exhibit the phenomena indicated by Serullas; that is,
they were not thrown off with explosions accompanied with light and
caloric. The effects are, however, curious. The amalgamation of
the sodium takes place slowly, without any rotary motion; although
sometimes, when breathed upon, a motion of short duration is induc-
ed. When several pieces are put upon the bath at the same time,
they show no disposition to come together, but rather the contrary.
But when one piece is pushed towards another, there appears to be,
within a certain distance, an attractive force exerted, which is im-
mediately succeeded by a repulsive one of some comparative energy.
Many pieces being accumulated in a small space, they become vio-
lently agitated, as if alternately attracting and repelling each other,
until they finally separate.—Jbed.
On the Influence of successive Impulses of Light upon the Re-
tina, by Sir David Brewster.—From the remarkable experiment of
AT2. Scientific Intelligence.
Mrs. Griffiths, described in a former number,* it appears that the re-,
ticulated structure of the retina may be rendered visible by throwing
light suddenly on the closed eye, when in a state of repose, and es-
pecially in the morning, before the retina has been subjected to the
action of any other light.
In repeating this experiment, I have found that a remarkable
structure may be exhibited at any time, and whether the eyes are
open or shut, by subjecting the retina to the action of successive im-
pulses of light. If, when we are walking beside a high iron railing,
we direct the closed eye to the sun so that his light shall be succes-
sively interrupted by the iron rails, a structure resembling a kalei-
doscopic pattern, having the foramen centrale in its centre, will be
rudely seen. The pattern is not formed in distinct lines, but by
patches of reddish light of different degrees of intensity. When the
sun’s rays are powerful, and when their successive action has been
kept up for a short time, the whole field of vision is filled with a
brilliant pattern, as if it consisted of the brightest tartan, composed
of red and green squares of dazzling brightness. The green colours
prevail chiefly at the centre, corresponding to the foramen centrale,
and here we observe the dark-lined network pattern which I have
described in No. 20,+ and which is totally distinct from the reticu-
lated structure noticed by Mrs. Griffiths. The brilliancy of the spec-
trum thus produced, and the beauty of its colours, exceed any optical
phenomenon which I have witnessed, and so dazzling is its effect that
the eye is soon obliged to withdraw itself from its overpowering in-
fluence.
The very same phenomena may be seen by looking at the sun
through the distended fingers when they are made to move back-
wards and forwards, or rather from right to left, and from left to
right, in front of the eye.
‘The colours of the spectrum above described have their origin in
the red light transmitted through the eyelids, the green tints being
the accidental or complementary colour of the red; but the pheno-
menon may be seen in a great measure without colour by opening
the eye, and interposing between the eye and the sun any white
transparent ground, such as thin white paper or ground glass, or by
directing the eye immediately to a bright sky, or to the ground when
covered with snow. In these different forms of the experiment the
effect varies greatly with the intensity of the light and the state of
the eye, but the following general description of the phenomena will
be found tolerably correct. In order to make the light produce a
series of successive impulses on the retina, and on the same parts of —
it, | look through the openings of the resolving disc of the phenakis-
tiscope with one eye, and fix it steadily upon the same point of the
luminous ground.
* See London and Edinburgh Philosophical Magazine, vol. iv. p. 43.
7 Ibid, p. 119, note.
fy 6
Scientific Intelligence. A73
When the dise revolves with great velocity, a very faint and
uniform light is seen over the whole luminous surface. As the ve-.
locity diminishes, the light becomes less uniform’, and a flickering or
wavering motion commences. Patches of a bluish purple colour ap-
pear in different parts of the field, forming a sort of network, the in-
tersections between the meshes of which are of a faint lemon-yellow.
colour, the accidental colour of the bluish purple. The pattern of
this network is related to the centre or point on which the eye is
fixed, and seems to belong either to a hexagonal or octagonal division
of the circle. The centre of the pattern, corresponding to the foramen
centrale, is a square or lozenge, one of whose diagonals is vertical :
but as the differently coloured patches or elements of the pattern are
constantly changing their colour, their intensity of light, and even
their form, owing to the unsteadiness of the eye and the revolving
disc, I have never been able to draw the pattern, or to trace how the
patches or interstices of the network spring from the sides and angles
of the central lozenge. That the reticulated structure is related to
this central square or to the central foramen of the eye is unquestion-
able; and I have no doubt that observers who have younger eyes
than mine, and who shall have the courage to repeat the experi-
ments with the direct light of the sun, and with a disc having narrow
slits, and revolving upon a fixed axis so as to have its velocity uni-
form, will be able to obtain an accurate representation of the pattern
in question.
Within and around the central lozenge, is seen with great dis-
tinctness the dark-lined network pattern already mentioned, and ap-
parently unconnected with the larger pattern. As the spaces, how-
ever, or patches, which compose the larger pattern diminish in size
towards the centre, it is possible that the dark-lined net-work, with
dark specks in the centre of the figures, and having all the regularity
of 2 geometrical figure drawn with ink, may be the central part of
the larger patterns seen more distinctly by direct vision; but I can-
not admit this notion, because under favourable circumstances a
similar dark-lined pattern, with extremely small spaces between the
meshes, appears throughout the rest of the field of view, especially
in the external part of it where it first begins to show itself.
The colours which appear in the principal pattern are chiefly
bluish purple, and its complementary colour lemon-yellow, but as
the former increases in depth or approaches to blackness, the latter
becomes more white. These different colours sometimes appear in
the different patches of the pattern, and sometimes they appear in
succession over a considerable part of the field. They are, however,
most distinctly seen in the central lozenge, the inner part being
sometimes purple and then yellow, while the outer part of it is first
yellow and then purple. The central lozenge is sometimes marked
out by whitish, and sometimes by greenish light, and I have fre-
quently seen in its centre a blush-red of a very rare tint. The suc-
i
474 Scientific Intelligence.
cession of colours in the lozenge is very beautiful, each colour ad-
vancing to the centre, replacing that which preceded it, and then
disappearing. |
The cause of the colours themselves is obvious. The action of
white light on the retina renders it first insensible to the red rays,*
and consequently a white object or ground appears bluish purple or
blue in solar light, and green in candle light, the colour varying with
the intensity of the exciting light, and with the distance of the image
of the white object from the excited point. The other colour which
appears in the preceding experiments is a faint lemon-yellow, which
is the complementary colour of the bluzsh purple. It deserves also
to be noticed, that these colours are the very same as those produced
by the action of light falling on the retina at a distance from the
axis of vision. When we look, for example, indirectly, or rather
obliquely, at a candle for some time, the image of the candle itself
becomes bluish purple surrounded with a nebulosity of yellow light,
the accidental colour being the invariable companion of the primitive
one.
In order to explain why no colours appear during a very rapid
rotation of the disc, and why the primitive and the accidental colour
succeed each other in the pattern, let us call
T the time in which the disc revolves,
m the number of apertures in its margin,
D the duration of the impression of direct light, and
d the duration of its complementary colour.
It is obvious that * will be the time which elapses between each
n
consecutive impulse of light on the retina, or the time during which
the eye has the opake part of the disc opposite the pupil. When
fe
— is very small, or the velocity very great, or when — is very much
n n
less than D, (D is = eight-thirds, or nearly one-eighth of a second,)
the ground will be uniformly luminous, because the direct impression
of the one aperture has not begun to fade away before the succeed-
: T
ing aperture makes a new impression. When = however, is nearly
equal to D, the impression of the direct light is nearly gone, and
hence arises the flickering or wavering appearance of the luminous
ground, which becomes a maximum when Zab: for when this
takes place, the direct impression of the one aperture is just gone
ne
before the other aperture renews it. When— is greater than D, the
n
accidental colour of the direct impression begins to show itself; and
* See Lond. and Edinb. Phil. Mag., vol. iii. p. 169.
Scientific Intelligence. 475
a
when
= Dees: the accidental colour will be about its brightest,
and will be seen to succeed the direct impression, the latter being
now bluish purple, and the former lemon-yellow. When =D
-++d, the opake space between the apertures will begin to be visible,
and the phenomena will disappear.
As the reticulated pattern is marked out by different colours
and even by the same colour in different states of intensity, it
follows that different parts of the retina have different degrees of sen-
sibility to light. The lines which form the network are probably
thicker than the interstices between them, and consequently less
susceptible to luminous impressions. In like manner the interstices
nearest to the foramen centrale are probably thinner than those more
remote, and hence it is easy to understand why they exhibit a greater
sensibility and a more rapid change of colour. If these views are
correct, we not only obtain a general explanation of the phenomena
which we have described, but of many others which have hitherto
perplexed the optical physiologist, and among these we may enume-
rate the phenomena of oblique vision, and the superior distinctness of
objects when they are seen directly along the axis of the eye.
In a former paper I had occasion to mention a very remarkable
fact, which I had long ago discovered, that the intensity of a given
light may be increased physiologically by causing it to act upon the
retina by successive impulses of a given duration. Those who may
repeat the preceding experiments will obtain an ocular demonstration
of the truth of this new property of light. The maximum physiolo-
gical intensity seems to take place when te is nearly equal to D +d.
—Tbid.
NATURAL HISTORY.
Remarkable Skulls found in Peru.—In the Second Part of the
Fifth Vol. of the Leztschrift fiir Phystologie, Tiedemann gives the
following short but interesting notice :
During my late visit to Paris, I saw, in the Museum of Compa-
rative Anatony, at the Jardin du Roi, several skulls brought by Mr.
J. R. Pentland from Peru, where he found them in sepulchres of a
very ancient date. ‘These skulls are remarkable for their unusually
great length, the axis from the forehead to the occiput being much
longer than what is observed in any other skulls I have seen, while
the lateral axis is proportionably shorter, in consequence of which
they seem compressed at the sides. The face is exceedingly project-
ing, and the forehead very retreating, so that the facial angle of
476 Scientific Intelligence.
Camper is smaller than in any known race of man. The os frontis
‘is continued far backwards towards the vertex, and is very long,
narrow, and flat. The parietal bones look partly backwards, and
where they join the frontal bone make a remarkable arch or protu-
berance. The occipital foramen is large, and its plane looks not
downwards and forwards, but somewhat backwards. The zygomatic
processes are not prominent. Mr. Pentland has given me the fol-
lowing information concerning these extraordinary skulls :
‘The singularly shaped skulls which excited your attention, I
obtained in 1827, in the Province of Upper Peru, now, called Bolivia.
They seem to belong to an extinct race of mankind. I found them
in the ancient graves called Huacas, in the great alpine valley of
Titicaca, which is likewise remarkable for being the country in which
civilization, planted by the Peruvians, flourished to a degree unrivalled
among the other tribes of the new world. These sepulchres have
the form of high round towers, and in some places are constructed
of enormous masses of masonry. The stones are very carefully and
skilfully arranged, in a manner similar to that observed in the old
structures of Greece and Italy, named by our antiquarians Cyclo-
pean. I have met them only in the valley of Titicaca, which extends
from the seventeenth to the nineteenth degree of latitude (south), and
on the skirts of the Andes which form that valley. They occur in
the greatest abundance in the Provinces of La Paz, Oruro, Pacages,
and Carangas. I examined several hundreds of these sepulchres, and
in all of them found human skeletons, and in all the skull had the
same singular shape. The skeletons are in a state of excellent pre-
servation, a circumstance attributable to the great dryness of the
climate, the country being situated about two thousand toises above
the level of the sea. The skeletons belonged to persons of all ages
from the youngest child to the oldest man. All the heads, young
and old, had the same form, from which I conceive that it may be
with justice inferred that their peculiar shape was not artificially
caused by pressure, as is the case with the Caribs, and some other of
the barbarous tribes of the new world.* The heads presented to the
French museum were.selected from a great number, and were found
in the following places, viz.: the island in the lake of Titicaca,
Chunguys, Tiaguanaco, Licasica, Tolapalea, and Lennas. The pre-
sent inhabitants of the interior of Peru belong to the same race which
peopled the remainder of the continent of South America, and which
is distinguished by a copper colour of the skin, a thinly scattered
beard, straight strong black hair, and a prominent nose. Iam of
opinion that the present inhabitants of Peru are derived from an
Asiatic stock, the last colony of whom migrated probably about the
twelfth century. From these latter settlers sprung the dynasty
of the Incas or Ingas, which dynasty was overthrown by the Spa-
niards, after it had lasted about twelve generations. The Asiatic
emigrants had gradually spread themselves over the western coast of
Scientific Intelligence. 477
South America, conquering, as they spread, the natives of the
country; and it is to the latter, in all probability, that the skulls in
question belonged. Many sepulchres of the present race of Peruvian
Indians occur along the coast of the Pacific Ocean, the skulls found
in which agree in every respect with the form of that race, but ia
‘no instances do they possess the peculiar characters of those found
in the interior. A careful examination of these skulls has convinced
me that their peculiar shape cannot be owing to artificial pressure.
The great elongation of the face and the direction of the plane of the
occipital bone are not to be reconciled with this opinion, and therefore
we must conclude that the peculiarity of shape depends on a natural
conformation. _ If this view of the subject be correct, it follows that
these skulls belonged to a race of mankind now extinct, and which
differed from. any now existing.”
‘‘ From this very valuable communication of Mr. Pentland,” says
Tiedemann, ‘‘ we are justified in inferring that the continent of Ame-
rica was inhabited by aborigines, who belonged to a race of mankind
differing from every other in several important particulars, viz.: a
great projection of the face, great length, flatness, and narrowness of
the os frontis, prominence of the back part of the cranium, an eXx-
ceedingly small facial angle, and an unusual direction of the plane of
the occipital foramen. "This race has in the course of ages become
extinct, and was probably extirpated by their foreign conquerors.”
Communication from Professor Scouler on the above subject.—
The following observations on the above notice concerning the Peru-
vian skulls, is well worthy of attention, as coming from the pen of an
eminent naturalist, Professor Scouler, who has visited some of the
countries in question, and has himself brought to Europe .similar |
skulls ; and on whose recent appointment to the chair of Natural His-
tory in ‘the Royal Dublin Society, we most sincerely congratulate the
Irish public.
‘“The Peruvian cranium described by Tiedemann in the preceding
article, possesses so very remarkable a configuration, that we would
be tempted to adopt his epinion that it belonged to an original and
primitive race, if we were certain that its form had not been produced
“by artificial means. If we remember that the practice of deforming
the head by means of pressure has been very general throughout
America, and the result has been the production of crania as anoma-
lous as those of the ancient Peruvians, we will rather admit that in
this instance also compression has been employed. We are aware
that the possibility of deforming the cranium by the application of
continued pressure has been denied by able anatomists ; but it is un-
necessary to examine their reasonings in a case where we can appeal
to positive facts. That the Caribs of St. Vincent’s flattened the heads
of their children is well known, and an inspection of Blumenbach’s
engraving of a Caribbean skull, will convince any one of the grea
9
VOL. v. NO. 195. IQ
478 Scientific Intelligence.
amount of deformity which may be produced.* The same custom
prevailed in Carolina according to Adair, and at the present moment
it is practised by the Indians inhabiting the banks of the Columbia
yiver and Nootka Sound; of the authenticity of this fact, as far as
regards the Indians of the Columbia river, we can entertain no doubt,
as we have enjoyed ample opportunities of witnessing every stage of
the process, and have in our possession a complete series of skulls, in
some of which the deformity is as great as in the Peruvian skull
figured by Tiedemann.+ Among the Columbian tribes, the child,
immediately after birth, is put intoa cradle of a peculiar construction,
and pressure is applied to the forehead and oceiput. After the head has
been compressed for several months, it exhibits a most hideous ap-
pearance ; the antero-posterior diameter is the smallest, while the
breadth from side to side above the ears is enormous, thus reversing
the natural measurements of the cranium. As the individual increases
in years the deformity becomes less, but even in the adult persons it
is very great; from the excessive depression of the forehead the eyes
appear as if turned upwards, a circumstance which gives a very pe-
culiar physiognomy to the Indian. The process is slow and gentle,
so that the child does not appear to suffer in any way from so unna-
tural a process, nor do the intellectual qualities of the individual
appear to be in any degree affected by it; on the contrary, a flat head
is esteemed an honour, and distinguishes the freeman from the slave.
‘¢ These circumstances are sufficient to establish the fact, that
the human cranium may be distorted by artificial means, and thus
render it probable that the skulls of the ancient Peruvians may have
been disfigured by the same process. This opinion is greatly strength-
ened by other circumstances. Blumenbach has figured a deformed
and compressed Peruvian cranium from Quilea,} the form is different
from that of the skull represented by Tiedemann, and from those of
the Indians of North West America, but different modes and degrees
of compression will produce different kinds of deformity. We have
in our possession a skull in which the pressure has been applied dia-
gonally from the left half of the frontal to the right half of the occipital
bone. In addition to these facts, we have the testimony of historians
and travellers, that it was the practice in Peru to compress the heads
of the children. The following authorities, as quoted by Blumenbach,
are sufficient to establish this point. Dela Condamine informs us that
the custom prevails in South America, and that it was known to the
Peruvians, and in the year 1585, the synod of Lima prohibited the
custom under the pain of ecclesiastical punishments. The synod
alludes to the practice as universally prevalent in Peru, and that it
OO re a er a a ae he
* Blumenbach, Decades Craniorum, tab. xx.
+ Seouler, Zoological Journal, where an account of the.mode of compression,
and figures of the compressing machine, and of an adult and infant skull, are given.
* Blumenbach, Decades Craniorum, tab. xly.
Scientific Inteiligence. 479
has fallen into disuse since the arrival of the Spaniards in that
country.* is
‘These facts are sufficient to prove the possibility of modifying
the human cranium by means of pressure, that the custom was very
general throughout North and South America, and that the practice
prevailed among the ancient Peruvians: consequently, it is more
probable that the ancient skulls of Titicaca owed their strange confi-
guration to a process which we know is capable explaining the phe-
nomena, than that they constituted an original race, a circumstance
of which we have no other evidence than that derived from the shape
of the cranium.
‘The accompanying sketch of the infant skull of the Columbian
tribes, will give an accurate idea of the form of the head produced by
pressure.”
Men
= \
— S
Ss
OD et INGA
hy YW ; Z i) : , LE
WAZ p Z
ay ° 3 4 © EZ —
Mode of Flattening the Head among the Tribes on the Colum-
éia.—The abominable custom of flattening their heads prevails among
them all. Immediately after birth the infant is placed in a kind of
oblong cradle formed like a trough, with moss under it. One end,
on which the head reposes, is more elevated than the rest. A pad-
ding is then placed on the forehead with a piece of cedar-bark over it,
and by means of cords passed through small holes on each side of the
cradle the padding is pressed against the head. It is kept in this manner
upwards of a year, and the process is not I believe attended with much
pain. The appearance of the infant, however, while in this state of
compression, is frightful, and its little black eyes, forced out by the
tightness of the bandages, resemble those of a mouse choked ina trap.
When released from this inhuman process, the head is perfectly
padet | hittin ae seater a
* Blumenbach de Generis Humani Varietate Natura, p. 220.
480 Scientific Intelligence.
flattened, and the upper part of it seldom exceeds an inch in thick-
ness. It never afterwards recovers its rotundity. They deem this
an essential point of beauty, and the most devoted adherent of our
first Charles never entertained a stronger aversion to a Round-head
than these savages.*
They allege, as an excuse for this custom, that all their slaves
have round heads; and accordingly every child of a bondsman, who
is not adopted by the tribe, inherits not only his father’s degradation,
but his parental rotundity of cranium.—Cox’s Travels on the Colum-
bra Raver.
Rapidity of Vegetable Organization.—The vegetable kingdom
presents us with innumerable instances, not only of the extraordinary
divisibility of matter, but of its activity, in the almost incredible
rapid development of cellular structure in certain plants. Thus the
Bovista giganteum (a species of fungus) has been known to acquire
the size of a gourd in one night. Now supposing, with Professor
Lindley, that the cellules of this plant are not less than the 51th
of an inch in diameter, a plant of the above size will contain no
less than 47.000.000.000 cellules; so that, supposing it to have
grown in the course of twelve hours, its cellules must have been de-
veloped at the rate of nearly 4.000.000.000 per hour, or of more than
sixty-six millions in a minute!* and when we consider that every
one of these cellules must be composed of innumerable molecules,
each one of which is again composed of others, we are perfectly over-
whelmed with the minuteness and number of the parts employed in
this single production of nature.— Prout, Bridgewater Treatise.
tie’
Introduction of Frogs into Ireland.—It is not generally known
that the introduction of frogs into Ireland is of comparatively recent
date. In the seventeenth number of the Dublin University Maga-
zine, there is a quotation from the writings of Donat, who was him-
self an Irishman, and Bishop of Fesule, near Florence, and who,
about the year 820, wrote a brief description of Ireland, in which the
following passage occurs:
‘Nulla venena nocent, nec serpens serpit in herba
Nec conquesta canit garrula rana lacu.”’
‘¢ At this very hour,” says our respected contemporary, ‘we have
neither snakes nor venemous reptiles in this island, and we know,
that for the first time, frog spawn was brought from England, in
the year 1696, by one of the Fellows of Trinity College, Dublin,
and placed in a ditch in the University park or pleasure ground, from
which these very prolific colonists sent out their croaking detach-
* Dr. Swan, on'examining the skulls I had taken, candidly confessed that
‘nothing short of ocular demonstration could have convinced him of the possibility
of moulding the human head into such a form.
} Introduction to Botany, page 7.
Scientific I. ntelligence. 481
ments through the adjacent country, whose progeny spread from field
to field throughout the whole kingdom. No statue has yet been
erected to the memory of the natural philosopher who enriched our
island with so very valuable an importation of melodious and beautiful
creatures.”
We may state, however, that we have learned from good autho-
rity, that a recent importation of snakes has been made, and that
they are at present multiplying rapidly within a few miles of the tomb
of St. Patrick.—Eb.
ANATOMY AND PHYSIOLOGY.
Remarks on an Anastomosis recently observed outside of the
Liver, between the Vena Porte and the Vena Cava inferior, by Pro-
fessor Retzius, of Stockholm.—In the spring of 1832, being employed
in making preparations of the venous system, I met with various
venous branches, which, coming from the duodenum, left colon, and
rectum, formed a communication with and united themselves to the
vena cava inferior. Having put a ligature on the vena porte, where
it enters the liver, I injected this vein below the ligature with an
injection of a particular colour : in the same manner | filled the vena
cava inferior, with an injection of another colour. In displaying the
ramifications of the injected veins, I observed several small branches
of the same coming from the duodenum, and emptying themselves
into the neighbouring trunk of the vena cava inferior. Other ve-
nous branches coming from the left portion of the colon, joined the
emulgent vein of the left kidney. Further, I observed, that some
veins coming from the rectum, united themselves to the internal venous
network of the organs of generation. These latter were the largest
and most numerous. As the vena porte and the vena cava were
filled with differently coloured injections, it was easy to distinguish
the anastomosing branches by which they were connected. These
observations, made on the body of a boy aged five years, were con-
firmed in two other subjects of the same age. A very minute exami-
nation disclosed the existence of a thick network of very minute ve-
nous twigs in the cellular membrane outside the peritoneum. The
veins with which this network communicated were connected on the
one hand with the vena porte, on the other with the vena cava infe-
rior. When the peritoneum is fresh, thin, and transparent, the
largest of these vessels can be seen and traced with the naked eye.
When the injection succeeds well these vessels may be seen on the
posterior parietes of the abdomen proceeding to join the veins of the
colon. They at the same time form numerous anastomoses with the
veins of the kidnies, branches of the pelvic veins, as well as with
other veins which empty themselves into the inferior cava. From this
it appears that in the human body a communication exists between the
vena cava inferior, and the vena porte, which, so far as I am aware,
482 Scientific Intelligence.
has not yet been remarked by any writer. It can be most satisfac-
torily demonstrated by simultaneously injecting the trunks of the
vena portze, and of the vena cava inferior. The latter may be often
successfully injected, even to its minutest branches, for its valves do
not constantly present an obstacle capable of impeding the progress
of the injected fluid. In this manner I once succeeded in filling the
veins of the rectum with an injection from the vena cava inferior.
The fine injection passed from the cava chiefly into the venous net-
work of the cellular and muscular tunics of that intestine, while its
mucous membrane, on the contrary, was injected with the fluid that
had been thrown into the vena porte. I have made similar observa-
tions on the duodenum, and on some portions of the colon. It is more
than probable that a similar distribution of vessels occurs in all verte-
brated animals, in many of whom indeed Jacobson* has already an-
nounced its existence.
Professor Retzius is of opinion, that these numerous venous anas-
tomoses in the various networks of vessels he has observed in the
peritoneum, afford an explanation of the relief obtained by the appli-
cation of cupping glasses or leeches to the abdominal parietes, in cases
where the bowels or the peritoneum are inflamed, for the blood thus
drawn must influence not merely the circulation in the peritoneum,
which lines the abdominal parietes, but also the system of the vena
porte.—Zertschrift fur Physiologie, B. 5. H. i. p. 105.
Lymphatics in the Umbilical Cord.—In the last number of this
Journal, we inserted a notice of Fohman’s discovery and successful
injection of lymphatics in the placenta and funis of the human race.
More recently a similar investigation has been undertaken, and with
an equally satisfactory result, by Dr. Montgomery of this city, who
has succeeded ‘in injecting with mercury great numbers of these deli-
cate vessels running along the cord, and, for the most part, following
the-spiral course of the umbilical arteries.
_ Difference between Growth and Development.—In treating of
precocious growth, M. Isidore St. Hilaire draws a nice line of dis-
tinction between growth and development in the following terms :
‘“‘ Growth is a gradual increase in each of the parts of the body,
independent of all change in their number, their structure, and their
functions. A development consists, on the contrary, essentially in
a modification, or a complete change more or less manifest.
‘In the phenomena of simple growth, all the conditions of the
existence of organs are preserved, except their volume. Every
phenomenon of true development, on the contrary, allowing for the
difference in the extent and intensity of the change, resembles those
* De Systemate Venoso Peculiari in permultis Animalibus observato.—Hob-
niz, 1821.
Scientific Intelligence. 483
remarkable transformations and metamorphoses of the embryotic age,
and of the foetal life.
‘‘ The eruption of the teeth of the first dentition ; that of the per-
manent teeth, and finally the period of puberty, mark in man and the
animals which approximate to him, three principal epochs of deve-
lopment, after each of which the general growth is commonly re-
tarded in a more or less marked degree. Thus, increase of stature is
very rapid up to the eruption of the primary teeth, it is still consi-
derable, although less, until the second dentition, and from this pe-
riod to puberty, its progress is still slower; after this last period it is
much less ; and almost always becomes nearly imperceptible, or ceases
altogether when puberty is completed.
‘“Growth and development, although essentially distinct, are
then intimately connected. A certain degree of growth in all the
organs brings in its train a new development. Every development,
on the other hand, marks the termination of one period of growth
and the commencement of another, during which the organs grow
more slowly; as if the newly developed apparatus had appropriated
to itself, or had concentrated on it a great part of the formative force,
before divided with more equality among all the organs, or (in more
exact terms, and banishing this abstract language, too long used by.
anatomists), because the newly developed apparatus, by the increased
activity of its own nutrition, necessarily diminishes the activity of
general nutrition.” pp. 188, 189.
The author then proceeds to show, that as developments indicated
by the eruption of the primary and permanent teeth, and the perfec-
tion of the genital organs, exert a controlling influence on the growth
of the human body, and that of other animals resembling man in
their organization; so on the other hand, growth influences deve-
velopment to a considerable extent: thus, when an infant grows
rapidly, the primary teeth appear early; their eruption occurring
shortly after birth, or even preceding it; on the.contrary, when the
general growth of an infant is slow, the eruption of the teeth is pro-
portionably retarded. The same remark applies equally to the influ-
ence of rapid or slow growth in hastening or retarding the eruption of
the permanent teeth, and the appearance of the signs of puberty.
The foregoing observations refer to the mutual influence which growth
and development exert on each other, while the normal relation is
maintained between them : but this relation is subject to occasional
derangement, as stated in the following passage.
‘‘ When a child increases in size prematurely, and attains a con-
siderable stature at an early age, the first symptoms of puberty always
appear unusually early. One of two things may then happen: either
the development of the genital organs may proceed slowly, and even
be suspended, notwithstanding its precocious commencement, or it
may proceed rapidly to completion. p. 192.
‘‘ In the former case, the development of the genital organs being
slow and incomplete, the general growth continues to proceed rapidly ;
the stature, already considerable before the appearance of the first
484 Scientific Intelligence.
‘signs of puberty, increases still after their appearance, and becomes
gigantic. Hence the small size and inactivity of the sexual organs
in giants, and consequent impotence.” p. 192.
The author next points out the effects produced in those preco-
cious individuals, by suspension of the general growth, and a rapid
development of the genital organs. Such persons have the period
of puberty early completed, and do not exceed the middle size, or
even fall short of it.
It is further remarked, that precocious growth of the body, gene-
nerally, is more common in males, and precocious development of
the sexual organs, or of the period of puberty, in females. Another
physiological fact in the history of precocious individuals, is that often
the eruption of the teeth, far from having been precocious, was un-
usually slow. . The reverse, however, has been observed.
Precocious children have in general had voracious appetites.
Sometimes the growth became very rapid during a fit of illness. In
girls it has supervened on a suppression of the menses. But it often
commences from the time of birth, without appearing to depend on
any obvious cause.
Precocity of growth does not usually affect many individuals of
the same family; nor does it seem to be hereditary. The generality
of precocious children have died at an early age. A few of the more
remarkable cases of precocious development on record are quoted, in
which the characters above enumerated were manifest, and for the de-
tails of which we must refer to the work itself.
In the cases of precocious development of the genital organs
heretofore related, the accompanying state of the cerebellum has not
been so particularly stated as to afford any argument for or against the
doctrine of Gall, as to the connexion between this part of the brain
and the venereal appetite. On this point the author remarks, however,
‘‘according to the doctrine of Gall, we should not expect that all
children remarkable for their growth and precocious puberty, would
present a more than ordinary development in the cerebellum; for
children, who have prematurely exhibited marks of puberty, expe-
rience no venereal desire, while other individuals have been seen
having no marks of puberty, and presenting nothing particular in the
state of their genital organs, yet tormented with very ardent desires.”’
p-. 203.
The section on precocious growth, is closed with a short notice
on the anomalies of size observed in the foetus at La Maternitié, where
it appears that tables are kept, in which it is recorded that the foetus
at birth has varied in length from eighteen to twenty-five inches.
PATHOLOGY AND THERAPEUTICS.
Tuberculous Diseases of Monkeys.—Dr. Reynaud, one of the
most accurate of the French pathologists, lately read a memoir before
Scientific Intelligence. 485
the Academy of Medicine, Paris, on the tuberculous affection in
monkeys, compared with the same affection in man. The following
are the principal facts established by this interesting piece of compa-
rative pathology, to which we refer those who wish for more extensive
or more exact information on the subject. It is published in the
Archives de Médecine, vol. xxv. pp. 149—171, and pp. 301—326.
1. Nearly all the quadrumana brought to Europe die tuberculous.
This has been attributed to confinement and to change of climate ;
but till we know of what diseases they die in their wild state and in
their native country, such opinions must remain conjectural. :
2. The tuberculous deposition is more abundant, and at the same
time is diffused through a greater number of organs, than in man. —
3. The organs which the deposit affects are not the same. In the
monkey it is generally found in the kidneys, the spleen, and the liver;
often in the heart, very rarely in the mesenteric glands, or on the
peritoneum—never in the small intestine. The reverse of this occurs
inman. The lung is the most frequent seat of the disease in both;
but in the monkey the spleen is affected to almost the same extent,
and the tubercles soften with almost equal rapidity.
4. In all these respects the tuberculous affection in children forms
a sort of intermediate link between the disease in the human adult,
and in this family, inferior to ourselves in the zoological scale.
The following facts will serve at once to illustrate, confirm, and
limit these general principles.
Dr. Reynaud examined more than twenty monkeys that died at
the Garden of Plants in Paris. All with one exception died phthisical.
They had tubercles in the lungs, and likewise in several other organs.
Fifteen cases of which he took notes, form the basis of his observa-
tions. The species examined were udu ; but neither this, nor sex,
nor age, nor time of residence in Europe; influenced the uniformity
of the lesion, which was constantly tuberculous.
In the fifteen cases one was not tuberculous; fourteen had, tu-
‘bercles in the lungs; in three they were confined to the lungs; in
one they were extensively developed in these organs, while there
were a few tuberculous points in the mesenteric glands. In the ten
remaining cases, tubercles existed in several organs simultaneously.
- Dr. Reynaud had rarely an opportunity of examining the osseous
or the nervous systems. . The liver was fat (gros) in no instance ; in
man, on the contrary, this lesion occurred in 40 out of 120 cases
observed by Louis.* Pericarditis was met with in four of the cases ;
it was developed subsequently to the tubercles, and appeared to be
regulated by the same laws as pleuritis in the phthisical.
The lungs were in several cases entirely or in part converted into
tuberculous matter; none of the tissues remained ; all had undergone
the same transformation. Ulcerations were discovered twice in the
* Phthisie Pulmonaire, pp. 115, 116.
VOL. y. NO. 15.
Gd
486 Scientific Intelligence.
‘larynx ; never in the trachea or its two divisions. In man, ulcera-
tions of these parts occur in the majority of cases. Louis attributed
‘them to the inflammation excited by the matter expectorated. Now
‘it is singular, that in the monkey the cough is always dry, and unac-
companied by expectoration.
The bronchial glands were always more or less implicated in the
tuberculous affection. In one case their enlargement had completely
obliterated the left bronchus, and thus obstructed respiration in the
corresponding lung, which, as well as the side of the thorax, was
much contracted.
The spleen in two cases contained a few crude tubercles. In the
six remaining cases it was completely stuffed with this morbid pro-
duct, enlarged, deformed, and often adherent to the peritoneum.
The blood in the cells formed reddish clots, in the midst of which
were tuberculous points. Tubercles in various stages of develop-
ment replaced the tissue of the organ; this deposit was sometimes
contained in caverns lined with a false membrane. In one case the
tubercles were isolated and crude in the lungs ; in the spleen, on the
contrary, they were large, and softened in the centre, thus consti-
‘tuting a true splenic phthisis.
Dr. Reynaud has made it highly probable that these alterations
take place in the blood contained in the cells, and do not commence
in the tissue of the spleen itself.
The stethoscope and percussion enable us to detect the changes
which take place in the thorax of these animals, as the following
-short abstract of a case will show :
A Papion, aged about five years ; in Europe eight months, cough-
ed, and had dyspnoea. The left side of the chest was clear on per-
cussion, the right was dull. ‘The respiration on the left side was
vesicular, mixed with rale; on the right it was cavernous, and gurg-
ling. There was cough, but no expectoration. The pulsations of
the heart could scarcely be counted.
Inspection.—On the left side there was a recent effusion of blood,
and false membranes in the pleura. Some crude and softened tubercles
were found in the lung. The right lung contained a great number of
tubercles isolated, and in irregular masses. One of the inferior lobes
-was converted into a large, puruient, tuberculous mass. The bron-
chial glands were enlarged and tuberculous. The spleen contained
a great many tubercles in various stages of softening, and caverns of
various sizes. The diver contained a few yellow crude tubercles. In
the Aidneys there were one or two. The epzploon was covered with
little semi-transparent granulations. The heart, perecardium, sto-
mach, and intestines, were healthy. The mesenteric glands un-
altered.
According to Louis and Dr. Reynaud’s calculations, the left lung
is more frequently tuberculous than the right, and to a greater degree ;
females are more subject to phthisis than males—children than adults ;
and in the division of animals which approaches nearest to ourselves,
Scientific Intelligence. 487
tuberculization is at its maximum of frequency, extent, and diffusion.
“Then,” says Dr. R., ‘‘ whether we consider man relatively to the
lung apparently most disposed to tubercles, and belonging to that
side of the body which, compared with the other, seems inferiorly
developed ;—whether we regard sex, age, or species,—tubercles fol-
low one constant order in their development—that of organie degrada-
tion.— Lancet, April 26, 1834.
Irregular Formation of the Breasts.—Tiedemann remarks on
this subject :* “* The human female presents irregularities of the breast
not less frequently than other mammalia. In addition to the instances
already recorded, I myself have observed the following :—In 1824,
Maria R., born in Hagenfeld, near Pforzheim, was admitted into our
Lying-in Hospital. Her left breast was furnished with two nipples,
each of which was enclosed within a separate areola. The supernu-
merary nipple was situated about three finger’s breadth beneath the
other. This breast on the whole was not larger than that of the right
side. She was delivered of a son, and milk came in as great abun-
dance from the supernumerary as from the other nipples.
In the year 1825, the bedy of a girl was brought into our dis-
secting room ; she was about twenty years old, her breasts were beau-
tifully formed, and well developed, but each furnished with two fully
formed nipples, surrounded by a common areola. | In 1829, the wife
of a Dutch soldier named Walter, called for the purpose of consulting
me, and during the examination of her chest, I observed, that the
left breast was provided with two nipples, each of which gaye milk,
and were surrounded with a common areola. She assured me that
her mother had exactly the same conformation.
Explanation of the Phenomena of Metallic Tinkling.—The
tinkling, properly so called, or that produced by a bubble, (bullaire,)
is produced by the breaking of a bubble of air in an effusion into the
thorax, or into a cavity whose parietes are endowed with metallic re-
sonance. The formation of the bubble conveys the idea that it must
have passed through some liquid to arrive at the attending gas, and bya
fistula opening into the liquids, through which the air that is introduced
assumes the form of a bubble by its momentary submersion. However,
we have seen in one of the observations quoted by Laennec, that bub-
bles of air had developed themselves by exhalation from the surface of
the effused liquid. But it is very rare that in such cases they should
give a metallic tinkling on breaking, because the cavity which con-
tains them not having any communication with the bronchi, will not
present a metallic resonance. From what I have said, one can un-
derstand that the bubble of air may come from different sources,
Since fistulas present many relations in their communication. Thus,
* Zeitschrift fir Physiologie, p. 110.
488 Scientific Intelligence.
in the great majority of cases, the bubble is owing to the entrance of
air from a bronchial fistula, into the effused fluid and below its surface.
At other times the fistula does not terminate in the liquid, but in a
quantity of purulent matter, which separates it from the gaseous ex-
pansion, so that the air in traversing the fistula raises in its passage
the purulent matter, in the form of bubble, and this breaking high
above the effused fluid, still produces the metallic effect. Finally,
we may admit that these tinkling bubbles may, as I have already re=
marked, be produced by the exhalation of gas at the surface of an
effused fluid, without any bronchial communication, and ‘that they
may sometimes resultfrom the introduction of gas into the pleural ca-
vity, by means of a communication from the stomach or intestines.
Of all these various sources of bubbles, the one which occurs most
frequently, and that which gives the most positive results is the first,
namely, that arising from air insinuating itself, through a fistula, from
the lung into the effused fluid; it is of that I intend to speak more
particularly in the following pages. :
The bubble will be single or it will consist of the union of several
bubbles, according to the unity or multiplicity of the several tubes
that may form it: its volume will be in a ratio corresponding with
the diameter of the fistula. Bubbles may burst as soon as they ar-
rive at the surface of the fluid; at other times, when that shall be
thick or viscous, they may remain unbroken for some time, until an
accidental motion of the chest cause their rupture: this accidental
motion of ‘the chest is not to be looked on as the cause of the tink-
ling.— Beau. Archives Generales de Medicine, vol. iv. March,
1834. . ;
Electricity for the Cure of Warts, by Albert G. Welch, of
Annapolis.—Having had during the past winter, when I attended
lectures on chemistry, frequent opportunities of trying experiments
‘with electricity, and having several warts on my hands, te get rid of
which I was exceedingly anxious, and having tried repeatedly the
efficacy of nitrate of silver, and other caustics, without any advantage,
1 determined to try the efficacy of electricity. I therefore commenced
by sending sparks through them, which was repeated for five minutes
daily, for five days, when to my great satisfaction, I found that they
had entirely disappeared, since which time they have not re-appeared,
which they did when removed by the knife, or by caustic.
As there may be others who would like to be clear of such dis-
ficuring excrescences, and as the mode of removing them may not be
generally known, if you think it worth publishing, I would be glad
if you would insert the same in your journal.— Baltimore Med. and
Surg. Journal, Oct., 1833.
Scientific Intelligence. 489
Relative Mortality of different Countries.
Periods Teenge Ratio Annual mortality
Countries, or number of jof the averagejin each million of
Epochs. . Deaths. | Population. inhabitants.
Sweden and Norway,| 1821 to 1825 79,900 |1 in 47inh. 21,300
Denmark, 1819 33,800 {1 ... 46 ... 22,400
European Russia, 1826 960,000 413.44) 22 22,700
Kingdom of Poland, | 1829 93,000 j1 .. 44 ... 22,700
Britannic Islands, 1818-1821 37'3;,000°.4 1 vee OO, see 18,200
Netherlands, 1827-1828 163,000 {1 ... 38... 26,500
Germany Proper, 1825-1828 290,000 {1 ... 45 ... 22,400
Prussia, 1821-1826 305, 000 TE se Oo vente ‘25,600
Austrian Empire, | 1828 675,000 |1-... 40 ... 25,000
France, 192521827 roi 808,200: 1)..3 39)... 25,600
Swiizerland, 1827-1828 50,000 ji ... 40 ... 25,000
Portugal, 1815-1819 92,000 jl .. 40 ... 25,000
Spain, 1801-1826 307,000 TEs 70: AO™ see: 25,000
Italy, 1822-1828 660,000) JT ise SO... 33,300
Greece, 1828 30,000) 1 “2280S: 33,300
Turkey in Europe, 1828 334,800. jl ©... 30%... 33,000
Northern Europe, aitsed es 2,972,100 jl ... 44 ... 22,700
Southern ditto, . ‘iliac’ 2,284,2005) 1 n05 30 1c 27,800
TOTAL, acta ae 5,206,000. i1. 2... 40° 220 |- ~ 20,900
According to this table, and many others of a more detailed
nature, there annually dies :
1 inhabitant in 28 in the Roman State, and the ancient Venetian
provinces ; 1 in 30 in Italy in general, Greece and Turkey; 1 in 39
in the Netherlands, France, and Prussia; | in 40 in Switzerland,
the Austrian empire, Portugal and Spain; 1 in 44 in European
Russia and Poland; 1 in 45 in Germany, ‘Denmark, and Sweden; 1
in 48 in Norway; 1 in 53 in Ireland; 1 in 58 in England; 1 in
59 in Scotland and Iceland.
These numbers present the following results:
The smallest chances of life and its shortest duration are not, as
one might believe, amongst the effects of the rigorous climate of
Norway, or the marshy soil of Ireland ; it is in the beautiful climate
of [taly that life is reduced to its minimum extent. On the contrary,
it is among the icy rocks of Iceland, in the midst of the eternal fogs
‘of Scotland, where man attains his greatest age.
Of all-the European States, the British isles are, in this respect,
the most favoured; of each million of inhabitants, they only lose
18,200, whilst the mortality is almost donble in the countries wash-
ed by the Mediterranean. )
' Life, next to these, is most certain in Norway and Sweden. Ce-
_teris paribus, three people die in the south of Europe, two only and
490 Scientific Intelligence.
hardly that, die in ancient Scandinavia. Denmark and Germany en-
joy, as it were, similar advantages. phe
Russia and Poland, where nature and fortune have not been la-
vish of the necessaries of life, enjoy, however, an astonishing lon-
gevity. The population, comprising a mass of nearly sixty millions,
spin out their existence almost one half longer than that which is en-
joyed by the inhabitants of Italy, and exactly twice the length of time
which any one can expect to live in the capital of Austria.
The average time of life which only cuts off one victim in 40 an-
nually, is to be found in the Cantons of Switzerland, the Austrian
Provinces, and in the Spanish Peninsula, in consequence of the sun
and the dryness of the air.
France, the Netherlands, and Prussia, nearly reach the same
term, and will soon get beyond it, unless war or some other scourge
arrests the progress of their social amelioration.
In the rest of Europe, the mortality amounts to one-thirtieth of
the population, and is even frequently increased by accidental causes,
which have for a long time endangered the prosperity of the shores
of the Mediterranean.
On the whole, we reckon, one year with onother, 5,256,000
deaths in 210 millions of people, by a mortality of one-fortieth part,
which is unequally distributed among the northern and southern
states. The former have only one death in 44, the latter, one in
36 persons. Of one million of inhabitants in districts situated in the
north of France, 22,700 die; 27,000 die in those which lie towards
the south. This is a difference of more than 5,000 deaths, equiva-
lent toa two-hundreth part of the population.
If we carefully examine these numbers and those of the tables of
details from which they are extracted, we will discover that two great
causes which predominate over all the others, determine the ratio of
mortality to the population, or, in other words, regulate the number
of the chances of human life, These are the influence of climate and
civilization.
The climate is peculiarly favourable to the prolongation of human
life when it is cold or even rigorous, or when the humidity in the en-
virons of the sea is combined with a low temperature.
The smallest mortality in Europe, occurs in maritime countries
which are in the vicinity of the polar circle, such as Sweden, Nor-
way, and Iceland. This is also the case in countries where, as in
Russia, the influence of climate is not aided by civilization, and of
itself is sufficient to assure long life to mankind.
Countries where the heat is moderate, are not, as might be sup-
posed, among those which possess the advantage of a small mortality ;
to obtain it, they must acquire the benefits of a high state of social
order.
The southern countries, the mild climate of which seems to be so
favourable to the human race, are, on the contrary, regions where
life is exposed to the greatest dangers. In the smiling plains of Italy,
Serentific Intelligence. 491
the chances of dying are one-half greater than those of cold and
fogey Scotland; and under the beautiful skies of Greece, the cer-
tainty of life is one-half less than among the ices of Iceland.
The places of the torrid zone, the mortality of which has been
calculated, show the pernicious influence which is exercised over the
existence of mankind by a high temperature.
Latitude:
6° 10’ Batavia, decrease of 1 in 264 inhabitants, Burrow.
10° 10! Trinidad, 1, — 27 ~ Official documents.
13° 54/ St. Lucie, 1 — 27 ——— Pugnet.
14° 44! Martinique, —_._ 1 ~— 28 —— M.deJ.
1o® 59 Guadaloupe, ai] 27 —— M.deJ.
18° 56’ Bombay, —— 1 — 20 ——— Transactions Acad.
23° 11’ Havanagh, 1 — 33 Humboldt.
The resistance of the vital principle in the tropics differs accord-
ing to the races of men ; and its duration in some places is, for the
one, double or triple that for the others. The following are exam-
ples of this variation :
Batavia, in 1805—Europeans, | in 11 individuals; Slaves, 1 in
13; Chinese, | in 29; Javanese, 1 in 46, Bombay, in 1815—
Europeans, 1 in 181; Mussulmen, | in 171; Parsees, | in 24.
Guadaloupe, 1816 to 1824—Whites, 1 in 231; Freedmen, 1 in 35.
Martinique, in 1815—Whites, | in 24; Freedmen, 1 in 33. Gre-
nada, 1811—Slaves, Pin 22. St. Lucia, in 1802—Slaves, 1 in 20.
We may compare this immense mortality in the torrid zone, with
that which occurs in Madeira, the only colonial establishment in the
temperate zone. Heberden has calculated, that the deaths in that
island were in the proportion of | to 49.89, of the whole inhabitants.
The effects that the degree of perfection, more or less extensive,
of the social economy exerts on mortality, are not less extensive than
those the cause of which is to be found in the influence of the cli-
mate. c
The influence of the progress of civilization is discovered by com-
paring the ratio of the deaths to the population of the same country
at epochs, the intervals of which have been marked by social ameli-
orations. The following series of universal terms presents an instruc-
tive comparison :
The number of deaths compared with that of the inhabitants was,
In Sweden, 1754 to 1763 1 in 34, in 1821 to 1825 1 in 45
— Denmark, 1751 to 1756 = 1 — 32 — 1849 1 — 45
— Germany, 1788 1 — 32 — 1825 1-— 45
— Prussia, L717 1 — 30 — 1821 to 1826 1 — 39
— Wurtemberg, 1749 t0. 1754. 1 — 32 — 1825 1 — 45
— Austria, 1822 1 — 40 — 1828 to 1880 1 — 43
— Holland, 1800 1 — 26 — 1824 1 — 40
— England, 1690 1 — 33 — 1821 1 — 58
— Great Britain, 1785 to 1789 1 — 43 — ¥800'to 1804 ~1°-— 47
— France, 1776 1-—263+- 1825 to 1827 4 — 398
—— Canton of Vaud, 1756 to 1766 1 — 35 — 1824 lL 947
—. Lombardy, 1769:to 1774. 1 — 272 — 1827 te 1628 a— 31
— Roman States, 1767 1 — 24 — 1829 1 = 28
— Scotland, 1801 1 — 44 — 1821 1.— 469
492 Scientific Intelligence.
Thus the mortality has diminished,—
In Sweden, nearly + in 61 years; in Denmark, 2 in 66 years ;
in Germany, % in 37 years ; in Prussia, } in 106 years; in Wurtem-
berg, 2 in 73 years; in Austria, 7’; In 7 years; in Holland, > in 24
years; in England, } in 131 years ; in Great Britain, 7, in 16 years;
in France, 1 in 50 years; in Canton of Vaud, 4+ in 64 years; in Lom-
bardy, 4 in 56 years; Roman States, 3 in 62 years.
For thirty years, the mortality has been stationary in Russia and
Norway; it has increased in the kingdom of Naples.
On the whole, there has been, for 80 years, a mortality of 1 in-
dividual in 36 throughout Europe, according to Sussmilch; our
calculations do not exceed | in. 40, according to the average of later
years. On the continent of Europe there has, therefore, been a
diminution of one-ninth in the mortality of the. aggregate of the
people, if we can rely on the ‘German writer on statistics. We are,
however, inclined to think, that, during his time, the mortality ge-
nerally was less than one-thirtieth of the population, which supposes
that itis more than one-third less at present in» proportion to the
augmentation of its population. | |
This gradual diminution of mortality arises from the same causes
in the principal towns in Europe. The number of deaths compared
with that of the inhabitants at distant epochs, gives the following
proportions :
Paris, in 1650 1 in 25inhab.; in 1829 1 in 32
London, — 1 b690 1— 24 — — 1828 1 — 55
Berlin, — 1755 1— 28 — — 1827 1 — 34
Geneva, — 1560 1— 18 — — 1821 1 — 43
Vienna, — 1750 1 — 20. — — 1829 1 — 25
Rome, in 1762-1771 1—2l1 — —- 1828 1 — 31
Amsterdam, in 1761-1770 1— 25 — — 1828 1 — 29
Cambridge, in 1811 1— 41 — — 1821 1 — 58
Norfolk, — 1811 1— 650 — — 1821 1 — 59
Manchester, ae Died, 1— 25 — — 1821 1 — 58
Birmingham, — 1811 1 — 303 -— — 1821 1 — 43
Liverpool, — 1773 r— 27° — — 1821 1 — 41
Portsmouth, — 1800 1— 28 — — 1811 1 — 38
Petersburg, — 1768 1-- 28 — — 1828 1 — 48
Stockholm, in 1758-1763 1—19 — — 1827 1 — 26
The annual mortality has also diminished in Paris, more than 4
in 80 years; in London, more than in 178 years; in Berlin, 4, or
nearly !, in 72 years; in Geneva, } in 261 years; in Vienna, } in
in 80 years; in Rome, } in 63 years; in Amsterdam, ¥ in 64 years ;
in Cambridge, 2 in 10 years; in Norfolk, 3} in 10 years; in Man-
chester, 2 in 64 years; in Birmingham, nearly 2 in 10 years; in
Liverpool, + in 38 years; in Portsmouth, more than + in 11 years ;
in Petersburgh, nearly 3 in 40 years; in Stockholm, more than } in
67 years.—LEdinburgh New Philosophical Journal, April, 1834.
Ricord’s Treatment of Ulceration of the Os Tince.—In some
patients who have exhibited ulceration of the os tineze running
Scientific Intelligence. 493
into the cavity of the womb, and of whom the uterine secretions have
been purulent, I have attempted cauterization of the internal surface
of this cavity. To this end, [ have had constructed a syringe with a
double cylinder, of which the pistons worked singly, and which en-
closed in one of its cylinders acidulous nitrate of mercury, diluted
with twelve parts of distilled water, and in the other pure water. Its
pipe, also double, is adapted to a eum elastic catheter, of about eight
inches in length, which, opened at its two extremities, and stheared
with a.greasy body, is introduced into the uterus. The injection of
the acidulous nitrate is then pushed gently, and in small quantity, to
the extent of about a small tea-spoon full, and after having allowed it
to remain for a minute or two, the watery injection is then pushed
on. Five patients affected with very abundant purulent uterine dis-
charges, and which had resisted all other means, have been thus
treated and cured in my clinical service at the Hépital des Vénériens.
I should state that I have only employed this means asa desperate re-
medy, and with all possible precautions, and that although I have never
had any troublesome cases, yet in some patients it has produced acci-
dents of short duration, but formidable in appearance, having deter-
mined in the greater number, instantaneous and very violent hysterical
attacks ; which, by the way, would tend to support the opinion of
those who place the seat of that disease in the womb.—London Me-
dical and Surgical Journal, May 24. ?
SURGERY.
New Herniul Bandages, by Messrs. Sanson and Cresson,
Kolian Pads.—In the Royal Academy of Medecine, sitting of the
4th March, M. J. Cloquet read, in his own name and that of Messrs.
P. Dubois and Harvez, of Chégoin, a report on these bandages.—
The principal inconvenience of all hernial bandages arises from the
substance which enters into the composition of the pad, and which
does not permit it to exercise at all times, a gentle, uniform, con-
stant, and graduated pressure, the only conditions to be fulfilled in
the treatment of hernia. All the substances employed until now
have the inconvenience of becoming wrinkled, hardened, &c. Messrs.
Cresson and Sanson happily had the idea of fabricating the pads with
Indian rubber; they have imagined three kinds:
Ist. Pads all of Indian rubber.
2d. Hollow pads, and filled with a quantity of air, which can be
augmented or diminished, which they call Eolian pads, with fixed air.
3d. Pads similar to the former, with this difference, that the air
can be let out or introduced at pleasure, and in different quantity :
Eolian pads with moveable air.
The exterior of all these pads is Indian rubber. The authors
have thought proper to cover them with gold leaf, which in adding to
VOL. V; No. 15; 3s
494 Scientific Intelligence.
the appearance and neatness, does not interfere with its other essen-
tial qualities. These pads, independent of the advantages of elas-
ticity, softness, &c., by their nature alone, are capable of any alter-
ation, however long they may be used. Experience has already con-
firmed their superiority over the ancient ones.— Revue Médicale.
Re-union of a Portion of the Thumb entirely separated.—
M. Beau, intern at Salpetriere, observed this case, the principal
points of which he recapitulates in the following manner :—Ist,
September 7th, 1833, the extremity of a thumb entirely divided
about the centre of the nail, after having been separated from the
body for more than half an hour, was replaced and maintained by
straps of adhesive plaster. 2d, The 15th, that is, eight days after,
the extremity was found re-united by an adhesion, which, although
weak on that day, was much more solid on the 18th. 3d. The nail
and epidermis separated from the subjacent parts, and leaving denuded
the end of the phalanx necrosed, retained in its place by a slight
eschar adhering to the soft parts, which alone are vitally re-united to
the corresponding soft parts of the finger. 4th., 21st. The necrosed
bone removed: the eschar, not detached until the 23d, cicatrization
complete on the 27th, twenty days after the separation of the extre-
mity of the thumb, and six days only after the first appearance of
pus.*—TJbid.
Caries of the Spine, Anatomical Society of Paris—M. Gen-
dron found the following alterations on the body of a child ten years
of age, who died from disease of the spine. The body of the second
cervical vertebra was completely denuded, and the intervertebral sub-
stance between that and the third vertebra entirely destroyed; a large
purulent collection surrounded the bones and carried forward the an-
terior muscles of the neck, and on the side, the aponeurotic sheath of
the long muscles of the neck, the muscular part of which was de-
stroyed : posteriorly, the sinus communicated with the vertebral canal
between the two vertebrze, above mentioned, and extended to the ba-
silar cavity (gouttzére baszlazre,) raising the dura mater and occipito-
axoidien ligament. The lumbar region presented also a caries with
a purulent accumulation.—Jbd.
Cancer of the Diploé.—A female subject with cancer of the
breast, in whom the two thigh bones were on one occasion fractured
by a very slight cause, was presented to M. Tessier, with cancerous
tumours developed in the interior of the medullary canal of each fe-
mur; the sides of the osseous cylinder were reduced to an extreme
thinness and fragility. The bones of the cranium presented also
several cancerous tumours at different stages of development, but
which all appeared to have their origin in the diploé.—Jdzd.
* See our last Number for a. case of reunion of a portion of the index fin-
ger.—Ep,
INDEX
TO THE FIFTH VOLUME.
mers
A.
. Page.
ACCOUCHEMENT, causes of presentation of the head in . . 139
Amputation at the shoulder joint, case of, by Mr. Porter . 199
Anastomosis, between the vena porte and cava. : . 481
Aneurism, popliteal, two cases of, by Mr. Coxtis. : 229
a case of double, . ; : ’ : 2b.
researches on, by Dr. Stokes, 4.00
occasioned by the sequestrum, in a case of necrosis 190
Antiphlogistic treatment, occasional bad effects of, in aneu-
risms of the large vessels : ~~. 430
Aorta, cases of aneurism of, ——. : : . 406-428
case of constriction of, by Mr. Nixon ; . 386
437
throbbing of, in enteritis : : ; : °
ArRrowsmitH, Dr., extract of aletter from, to Dr. Graves 383
Arsenic, use of, in scrofula . : : : : g - 366
) report of a case of poisoning with, by Dr. Bgatry . 203
Arteries, carotid, ligature of, in epilepsy > . TOT
torsion of, : . : : : ; ‘ ~ 157
femoral, wound of both without hzemorrhage : . 324
Artery, hepatic, aneurism of, ae : : : . 401
Arterial pathology, communication from Professor Harrison on 432
Arteria innominata, aneurism of . : ‘ : 3 - 406
Asphyxia, letter from Dr. WitL1aMs on. : : . 380
Asthma, use of turpentine in : ; ; ~~ ™. OL
Auscultation, obstetric, Dr. Kennedy on. Review. 1 UI89
Austria, mortality in . ; : : : —. - 489
B.
Bearry, Dr., a case of trial for poisoning by arsenic, by . 208
Buacx ey, Mr., on the cause of the pulse being affected by _
the position of the body oat : spas ow
VOL. v. NO. 15. 3T vay
&
496 INDEX.
Bladder, congenital extrophy of : ;
Blood, carcinomatous matter in , ; : : .
Blood, wormsin the . :
Botany, an introduction to, by John Lindley. Review.
Brain, on inflammatory affections of, by Dr. Morean . 3
Branchial openings in the neck of the human fcetus
Breasts, irregular formation of : : :
Brittanic islands, mortality of —. : ; : :
Branchitis, external use of turpentine in
Bronchus, tight, lodgement of a tooth in, by Dr. Hace TON
Bronchoteeny case of, by Mr. Porter
Bruit de soufilet, encephalic,
absence of, in aneurisms
C.
Calcareous spar, on a method of increasing the divergency of
the two rays in, so that only one image may be seen at a
time
Calculo-fractor, description of, by, Mr. DEstRaNGce :
Calcutta, transactions of medical and physical societies of. Re-
view.
Calladium BinaAgtiidivan development ae Foe in He foveal
of the
‘Camphor, rotatory movements of
Cancer, superficial, views of M. Lisfranc on
Caries of the spine. : : ; ;
Carswell, Dr., on cancer
Cartilages, ulceration of, Dr. O’ BetRNne Eon the use of Meurer in
Carcinomatous matter in the blood , . “
separate existence of
Casts in plaster, for the treatment of Boccia:
Cephaloma, nature of
Charcoal, disinfecting powers ¢ ob
Chest, contraction of .
@nintide of platinum and i of ie on some compounds
formed by the action of, by Mr. Kane .
Chlorine, influence of, on vegetation
Cholera among the insane
CuurcuiLy, Dr., cases of iterine hemcaaee by
Cicnta, experiments on .
Cinnamon of the ancients
Cities, mortality of various . :
Civilization, effects of on longevity
Club foot, section of tendo-achillis as a cure ‘for
CoLtis, Mr., two cases of popliteal aneurism, by
Constriction of aorta, case of, by Mr. Nixon
Crocodile, peculiarity in the respiration of the
Pt
e
A462
440
103
132
284
158
494
ab.
159
27:1
he
320
270
310
12
469
152
244
136
492
491
314
386
138
INDEX. 497.
< Page.
Croup in the eagle. : ; sy RO
Cusack, Dr.S. cases o. nervous 8 disease, by : 220%
Cyclopedia of practical medicine, part xix. Review. . . 269
D.
Death, apparent for twenty days . : 304
De Candolle, on the action of gases hurtful to vegetation, by . 469»
Decomposition, electro-chemical : (i404
Deer, Samber, appearances on dissection ate ‘ : 27286)
Denmark, mortality of 38 c ‘ . . 489°
Development, difference between growth and ‘ : . 482
Diploe, cancer of the : 494
Dubois, M., on the causes of the presentation of the head in
labour : : : : : : : ; ae hoe
E.
Eacer, Dr., considerations on scrofula, oe ‘ : . 344
Eisode wh : . 466
Electricity, Professor Faraday’ S discoveries i Mme 2 . 464
for the cure of warts ; ; : : . 488
Electric fluid, case of scorching by. : i : . 324
Electrode : : : : ‘ ; : : . 466
Electrolytes. ; ; ‘ . : ene:
Encephalic bruit de souffle : : ' ‘ 000
Enteritis, throbbing of the abdominal vessels i ite: . 438
Epilepsy, ligature of the carotid arteries in, by Mr. Preston 107.
Evanson, Dr., report of a case in which a foreign body was
supposed to be egal in the trachea. ‘ ; soprano
Exode . 466
Eye, on the supposed vision of the blood vessels of, ue Sir D.
Brewster - 2986
F. |
Faraday, Professor, recent discoveries of . , ; . 464
Finger, reunion of . 320
Flooding after delivery, from a morhid erowth ‘within the wierus 249
Foetus, human, branchial openings in the neck of - .olg
death of, use of auscultation in eG
Fohmann, Dr. V., discovery of Dn eae in the hunidn plan
centa and funis : pe 202
France, mortality of : : ‘ ‘ : : - 489
Frogs, introduction of, into Ireland. ; ‘ ‘ . 480
Cr.
Gases, hurtful to vegetation ; ; . 469
oxygen and hydrogen, recombination of. . . 465
Genital system, relations of, to the growth of the body. 484
498 INDEX.
Geology, principles of, by Mr. Lyell. Review.
Germany, notices concerning works on the practice of physic,
surgery, &c. “recently Eee in, ‘ch Dr.
Graves. Review
medical periodicals in
mortality of _ .
Graves, Dr., a lecture on the functions of the lymphatic system,
by. Review. : . ‘ i
Greece, mortality of : : 5
Growth, difference between, and development :
EE
Heemorrhage from between the placenta and chorion
uterine, cases of. By Dr. CHurcuIL .
Hair, development of : ‘
Harrison, Professor, letter on arterial pathology, from.
Hauser, Caspar, extracts from the life of
Head, mode of flattening the, among the tribes on the Colueibia
Hearing through the apertures made by the trephine .
Heart, on the mechanism of the sounds of, Py M. ipegpes
Henbane, experiments on “? : 3
Hernial bandages of gum elastic
Houston, Dr., a case in which a large molar ‘tooth entered ane
passed through the larynx during the opera-
tion of extraction, by ; : : :
on the diseases of certain animals
Hydrocyanic acid, test for ; :
l& J.
Incoherence, mental, occurring during natural labour. By Dr.
MonTGoMERY ; es
Iodine, effects of, in scrofula. By Dr. EacEr —
as an antidote for strychnine
JorERG, Dr., researches on solidification of ane fo in new
born infants, by ;
Joint, shoulder, amputation at the
Ireland, introduction of frogs into
Italy, mortality of
Jugular veins, distention of, in thoracic aneurisms
K.
Kawe, Mr., on some compounds formed by the action of chlo-
ride of platinum and chloride of tin
Kennedy, Dr., observations on obstetric auscultation, &e. Rev.
L.
Labour, natural, mental incoherence during .
Lead, acetate of, use of in phthisis
Page.
116
254
275
489
110
489
482
154
244
143
432
147
479
310
289
300
493
42
285
28k
52
344
303
36
199
480
489
423
%
.
ce
DEstrancs, Mr., description of the calculo-fractor, for pul-
verizing the calculus in the bladder, by ou
Light, effect of the want of, in producing scrofula
on the influence of the successive impulses of, upon the
retina : ; : : ; : :
Lindley, Professor, an introduction to botany, by. Review.
Lisfranc, views regarding superficial cancer - :
Lirrie, Dr., practical observations on the treatment of some
of the diseases of the lungs, &c, ‘ . ?.
Liver, neuralgia of the, Dr. Cusack on ote .
Lungs, solidification of, in new born infants, By Dr. Jozere
Lyell, Mr., principles of geology, by. Review. . : i
Lymphatics in the umbilical cord and placenta, discovery of,
‘by Fohmann . : : : . .
injection of, by Professor Montgomery
nature of, by Dr. Graves. Review
of the arm, disease of
M.
Macaw, transformation of the stomach in the ~
Magendie on the sounds of the heart :
Magneto-electric induction, general law of .
Marrow, spinal, influence of, on the circulation . : .
MaunseL1t, Dr., report of the obstetric practice of the
Wellesley Female Institution, during the year 1833
Mercury, proto-tartrate of, and potash, preparation of
on the use of, in the ulceration of the cartilages of
499
Page.
440
347
471
444
158
69
225
36
116
292
482
112
199
288
289
133
265
367
136
joints. By Dr. O’Berrne 159
Metals, influence of, on Caspar Hauser 149
Metallic tinkling, explanation of 3 487
Monkeys, tuberculous diseases of 484
, Dr. Houston on the diseases of : : ~ 285
MontGcomery, Dr., on the occurrence of mental incoherence
during natural labour 52
Mortality of different countries : * sasinpialiameadcs<cadieeoe
Morean, Dr., on inflammatory affections of the brain and its
_. membranes — ‘ . ; 232
Morphine, muriate, effects of . . : 206
Mummy powder, composition of —. od Low
Muriatic acid gas, influence of, on vegetation 470
| N.
Nerves, functions of the posterior and anterior roots of . _ 260
Nervous system, on certain functions of, by Dr. H. Stannius.
Review. . : : : : ‘ ; : ~ 255
Netherlands, mortality of ‘ : : 489
Neuralgia, visceral, diagnosis. By Dr. Cusack 296
ab
500 INDEX. =
Nitric acid, influence of, on vegetation
Nitrous acid gas, ditto ditto
Nipples, supernumerary > d . : :
Nixon, Mr., case of constriction of the aorta, by .
O.
O'Berrne, Dr., on the use of mercury in ulceration of the car-
tilages of the joints : : : : : :
O’Brien, Dr., report of a case of urinary calculi, containing
human teeth, removed from the female bladder
Opium, use of, in phthisis . ‘ :
Organization, rapidity of vegetable ; ‘ .
Os tincee, treatment of the ulceration of
e
2
Pads, Holian. d
Perineum, lacerated, treatment of
Periodicals, German . : ;
Peru, remarkable skulls found in |
Phthisis, Dr. Lirrie’s treatment of
use of opiumin ; : :
Placenta, glandular nature of, by Dr. Graves : : .
Pneumathorax, from perforation, a case of. By Mr. Poor .
Pneumatosis, extract from a letter on. By Dr. ARROWSMITH
Poisoning by arsenic and laudanum, case of. By Dr. Beatty
Poland, mortality of . : 5 i : :
Poote, Mr., a case of pneumothorax, by Bs : : °
Porrigo, treatment of . ; ; ; spa Sie :
Porter, Mr., surgical report of cases treated in the Meath
Hospital, during the past year . : :
Portugal, mortality of . : ; : ;
Potassium, cyanuret, poisonous effects of :
experiments with, by Professor Ducatel
Precocity, observations on .
Pregnancy, use of auscultation in : : :
Presse artere, description of. By Mr. CoLtis . : :
Prussia, mortality of . : :
Pubis, luxation of, in labour 5 ; :
Pulsation, violence of, in aneurismal tumours
Pulse, influence of position on. By Mr. BLackLey
R.
ee
Recto-vaginal septum, rupture of : :
Rectum, imperforate, case of. By Dr. MaunsELy
Respiration, inequality of, as a sign of aneurism
Page.
469
470
487
386
159
152
480
492
493
304
275
A75
84
152
151
185
383
203
489
185
302
189
489
303
470
483
89
35
489
tol
432
3032
308
375
425
* sili
| ~ENDEX. 501
Page.
Retina, influence of the successive impulses of light ape - 471
Ricord’s treatment of ulceration of the os tince . . 492
Rigas, Mr., medical cases and observations, by . .- ‘ 2
Roux, treatment of lacerated perineum : ; . 3808
Russia, European, mortality of . : 5 eas ; . 489
Rye, ergot of, dangerous effects from. pee eee ; . 376
S.
Sarsaparilla, formula for the preparation of the infusion. By
Dr. O’BEIRNE . i : f ‘ : 5 . 183
Schirroma, nature of . 270
Scouler, Professor, communication cau on the effect of pres:
sure on the skull ; 477
Scrofula, considerations ca the tents and dentate oF By
Dr. Hacer ; : . 344
Sequestrum in necrosis of ee tibia, producing aneurism P90
Skulls, remarkable, found in Peru : : ; : ~ 475
Soda, arsenite of, use of in scrofula : j ie : . 3866
Sodium, experiments with, by Professor Ducatel = 4 i ee TO
Souffle, placental, Dr. Kennedy on , : : ‘ °9 89
Spain, mortality of . : : : - 489
Spark during the freezing of water hy ether i ; oe
Spine, caries of the . : ; : » 494
Stannius, Dr. H., on the nervous system , 255
Stokes, Dr., researches on the diagnosis and pathology of
aneurisms, by - 400
Stromeyer, Professor, on the Soe of the tendo aobillte ov, lA
Stumps, neuralgic affections of . is ‘ » o3¥l
Sulphuretted hydrogen, influence of, on ‘vegetation a - 470
Suture twisted, in lacerated perineum . : oe . 306
Sweden and Norway, mortality of : ; ‘ aes 409
Switzerland, mortality of —. ‘ . 489
System, genital, relation of, to the erowth of the body . 483
ie
Tartarized antimony, singular effect from the application of . 17
Teeth, human, contained i in urinary calculi . ' : : 8
Temperature, the effect of, on longevity ; : : - 491
Terms, new electrical, by Professor Faraday ‘ . . 466
Tetanus, traumatic. j : : : . sal |
Theatres of dissection, purification of . : : : . ono
Thumb, reunion of portion of the : . 494
Tiedemann, observations on the Peruvian skulls, by ; < 4Gs
on the action and sounds of the heart —_ . 143
Tissues, white, reproduction of the ° : . : ~Ll4
Tooth, lodgment of, in the right bronchus. : : <a 42
502 INDEX. e
’ Page.
Trachea, report of in which a foreign body was supposed —
to be present in. By Dr. Evanson. 19
Trepan, operation of the, with relief of der engement « of the
brain, the result of injury. 192
hearing through the apertures made by . ; . 310
Tubercular diseases of monkeys . . . . . . 484
Turkey, in Europe, mortality of . . 489
Turnbull, A., M.D., on the external application of veratria.
Review. : 450
Turpentine, on the external application sof in the diseases of
the lungs. By Dr. LirrLe : : ; : FL. 08
U~.
Ulceration of the os tincee, treatment of : : : wie
‘Ulcer, malignant, remarks on, by Mr. Geddes : ° . 104
Umbilical cord, lymphatics in : : : Heat 482
Urinary calculi, containing human teeth : 8
Uterus, on rupture of the peritoneal coat of the. By Mr. Wu ITE 325
TR Le .
| Vv. *
Vaccination, experiment of M. Fiard . : : fy £5
Vegetation, on the actions of gases hurtful to . 469
‘Velpeau, M. views of, regarding exstrophy of the bladder seredga
Vena porte, anastomosis with vena cava : - 481
Veratria, an investigation into the effects of, by A. Turnbull,
M.D. Review. ° ; : ‘ ‘ . 45]
Vessels, white, Dr. Graves on the : ‘ orgie:
Voltaic circuit, continued rotation of a closed ; 5 - 134
=| ,
x ..* oS ® tell
Warts, electricity for the cure of . < : c . 488
Water, decomposition of, by sodium. 471
Wellesley Female Institution, report of. By Dr. MauNnseLL 367
Wurtz, Mr., on rupture of the peritoneal coat of the uterus . 325
WILLIAMS, Dr., on asphyxia ‘ : é : - 380
Wool, development obs : ‘ : : : : . 143
Worms in the blood -. : p ’ . : : - 322
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